Overprescribing, or polypharmacy, is when people take too many medications, at times including drugs that are no longer necessary. Multiple meds may lead to new illnesses, dangerous side effects, confusion and falls. An annual medication review with a health professional may result in deprescribing – discontinuing medications that are no longer beneficial.
Of course, we aren’t saying stop your medications. Many or all of a patient’s prescriptions and supplements are necessary for health as they age. We take drugs to manage chronic conditions such as diabetes, high-blood pressure, heart disease and chronic pain. We may also take over-the-counter (OTC) products to manage symptoms, such as headaches, swollen joints or digestive issues. For the most part, drugs prolong a patient’s life expectancy and improve their quality of life.
The Signs of Overprescribing
How do we know if someone is overprescribed? According to Camille Gagnon, PharmD MSc, Assistant Director of the Canadian Medication Appropriateness and Deprescribing Network at the University of Montreal, if the person is over age 65, the chances are fairly good. New evidence shows that 62% of people over 65 who live independently in communities take five or more meds; 24% of people over 65 taking 10 or more meds, rising to 36% for those over age 85.
Medication overload can result in drug interactions, falls and fractures, memory issues, hospitalizations and fatalities. People taking four to seven meds have a doubled risk of falling than those taking three or fewer.
It’s important to note, however, that older adults are a diverse group. 56% enjoy good health and are active in sports, jobs and volunteerism, Dr. Gagnon said during her October 2023 BC CRN Provincial Learning Event. She also advises that caregivers and service providers should observe older people for signs of over-medication which may be a form of elder abuse to gain power or control.
Medication: Risks Increase With Age
Beyond the fact that some drugs may no longer be required, there are other reasons to decrease doses or completely deprescribe a medication. As we age, our body composition changes which may lead to harmful side effects:
- Chronic conditions worsen. For example at age 62, we may require one medication for Type 2 diabetes whereas by 79, the average is three drugs. As conditions evolve and need different prescriptions, it’s important to ask if previous meds are still required.
- Bodies become more sensitive to the effects of drugs. The blood-brain barrier that protects our brains becomes more porous, potentially causing side effects like drowsiness or confusion.
- The liver and kidneys no longer excrete everything that is unneeded, so meds start to accumulate.
- Aging bodies have less muscle and more body fat; body fat stores some of the medication.
An example of this, Dr. Gagnon says, is the older person who is drowsy the day after taking a sleeping pill. The drug may linger in the person’s body fat and kidneys, passing through the porous blood-brain barrier to inhibit clear brain function.
Who’s At Risk of Medication Side Effects?
Anyone over the age of 65 is at risk of increased side effects from both prescription and OTC drugs. Multiple, chronic health conditions increase risk, especially if the patient sees various specialists. A longer life expectancy puts women at higher risk as they will likely develop more chronic conditions requiring treatment. Another factor affecting women is that female biology, such as body fat and hormones, tends to present different side effects than in men.
Another thing to look out for is “prescribing cascades,” when a prescription is added to deal with the side effects of another. It’s important to ask if the original medication is still appropriate, or if an alternative could do the same job with fewer side effects.
OTC drugs are easy to overlook and include everything from Advil, Tylenol, herbal supplements and vitamins to antacids and cannabis. They can affect or cancel the benefits of other medications, so be sure to mention them during health and medication reviews.
Deprescribing for Older People, When It’s Appropriate
Reducing or deprescribing a medication should only be done in collaboration with a healthcare professional, such as your pharmacist, doctor or nurse practitioner. At your appointment, tell them if you have any challenges, such as weakness, falls, loss of appetite or confusion.
Ask questions about any concerns, including:
- Why am I taking this medication?
- What are the potential benefits and harms of this drug?
- Can it affect my memory or cause me to fall?
- Who can I follow up with to stop or reduce a medication, and what are the risks and methods to do that?
Work with your healthcare professional to develop a plan to reduce or stop any medications deemed unnecessary. These professionals have experience in deprescribing and can support you to make any necessary changes. You may simply need a dose reduction, while other drugs need to be weaned from your system.
For Patients, Caregivers and BC CRN Service Providers
The Canadian Medication Appropriateness and Deprescribing Network website has a wealth of support and educational materials. Readers are invited to download current research and information materials, delve more deeply into the work the Network is supporting across Canada and access free articles to run in your own information campaigns by simply crediting the Network.
Watch Camille Gagnon’s deprescribing presentation to BC CRN members for more information.