Deprescribing in the elderly - Chris Cameron

Dr Chris Cameron talks about deprescribing in the elderly. Chris is a clinical pharmacologist and general physician at Wellington Hospital. Her interests are in improving safe prescribing practices in RMOs and the rationalisation of prescribing in the frail elderly.

Topics

Polypharmacy in New Zealand
Contributing factors
Risks to patient and prescriber when polypharmacy becomes problematic
Key points to ensure medicine optimisation
The practice of deprescribing
Commonly deprescribed drugs
Potential barriers to deprescribing
Recognising and confirming frailty, in context of medications a patient is taking
Primary healthcare collaboration towards deprescribing

Take home messages

Assessing function and falls risk is an important precursor to deprescribing discussion with patient, especially those over 80.
When looking at polypharmacy also consider the prescribing of potentially inappropriate medications, especially for the frail elderly.
Optimising medications means setting realistic goals for/with the patient - length vs quality of life, especially if frail.
Begin deprescribing by looking at meds that actually cause harm or could potentially cause harm, arent improving quality or length of life, and begin to titrate down.
Drug commonly deprescribed include: statins, beta blockers, anticoagulants, bisphosphonates, oral hypoglycaemics, proton pump inhibitors (dose decrease), anti hypertensives, psychotropics.