Updated August 27, 2021
what questions should I and my family be asking?
Am I taking the medicine for the right reasons?
Why am I taking these medicines? What condition are we treating?
Is it still needed? Has the condition changed?
Has the evidence for taking this medicine changed?
In my case, are the benefits greater than the risks of taking them?
Will I live long enough to gain its benefits?
Is the drug being used to treat a side effect only?
Can I stop it quickly or do I need to slowly go off of it if I need to?
What actions can i take for this agenda?
When you have a new symptom after starting a medication, look to see if it is a side effect and discuss this with your doctor
Always talk to your doctor before stopping any medication. If you do, check to see if you need to stop it slowly
Check if your prescriber can make the medication you’re taking simpler by taking it less if possible. The less frequently you have to take it the more likely you will commit to taking it
Check with your doctor if you can treat two diseases with one medication
Make sure you inform your doctor about any over-the-counter medication or supplements you are taking. Even Tylenol or Advil taken now and then should be mentioned. Other supplements such as natural fibers, teas, or home remedies should also be mentioned
Recognize that medications have a brand name and medical name as it can get confusing
Always bring all your medications to any healthcare visits especially to your family doctor, pharmacist, and geriatrician
What does taking “too many medicines” mean?
There is a concept in medicine called “Polypharmacy”
“Poly” means many and “Pharmacy” means medications
Taking a lot of medicines may be necessary despite being many
Usually, more than five different kinds are considered a lot
This topic focuses on medicines that we take that are not essential and potentially harmful for older adults
Some medicines work well on some older adults but not for others as our bodies are different
Even if you are taking a lot of medications, they may be essential for you
Never start or stop a new medication until talking to your doctor first
Why is taking many medicines a burden?
There is a greater chance for more side effects and drugs interacting with each other. Taking many pills will decrease your commitment (adherence) to take them correctly
They can also cause other issues such as the increased risk for falling, feeling tired, or having longer stays in hospital
Older adults have more fat in their body and their kidneys and livers aren't as sharp as they used to be
Many of these medications are handled differently in an older person's body compared to a younger person
Review the medications you’re taking each time you visit your doctor
Older adults have more body fat and less liver and kidney function. As such, medications can have different effects on them compared to younger adults
Why is this still an issue?
Some older adults take over the counter medicines or herbal medications without consulting their doctor
Others use multiple pharmacies to fill their prescriptions or have automatic refills which can cause an error by taking the wrong medicine for longer than needed
Some take medicines for many years not knowing why they are taking them. As we age, different long-term (chronic) diseases interact with one another making treatment complicated
Most studies and trials that look into medications exclude older adults
We apply these studies to older adults but the medications may not have the same effects or tolerance as they do in younger adults
What if I need these medicines?
Always check with your healthcare team and doctor before making changes to your medications
Even though you might be taking a great number of medications, they might be essential for your health
Never stop medications suddenly
do not take medicine only to treat a side effect of another medicine
Your family doctor or local pharmacy are great resources to help you learn more and answer your questions
Why is it complex? What can be done to make taking medications easier?
Older adults are sometimes expected to manage many of their medications and keep track of many pills with their frequency and dosage
They also have to keep track of what medicines are taken at scheduled times and which ones are taken only as needed
They also have to keep in mind which pills need to be taken with food and water and others that should not
One effective solution would be to use “blister packs”
Blister packing organizes your pills in a binder and easily shows you which pills to take at specific times in the day
It's affordable, saves time, and helps your doctor know what you're taking quickly and easily
Talk to your family doctor or local pharmacy about blister packing
blister packing makes it easier to take your medications as it groups your pills for the right time and day
How can I improve my chances to take my medicines correctly?
Committing to take your medications is called “adherence”
There are many ways to increase your adherence
Know why are you taking them and learn the most common side effects
Ask your doctor or pharmacy to see if they can look into options for affordability
The less complex and frequent a medication needs to be taken, the better
Having a family doctor or pharmacist review your medications
Blister packing your pills
always make sure you know why you are taking your medications and how to take them correctly
This will increase the likelihood of continuing to take your medicine and improves adherence
What resources can help with this agenda?
Deprescribe.org
Share and exchange information about deprescribing approaches and deprescribing research with the public, health care providers and researchers
deprescribingnetwork.ca
A group of health care leaders, clinicians, decision-makers, academic researchers and patient advocates working together to promote the deprescribing of medication that may no longer be of benefit or that may be causing harm.
Choosingwiselycanada.org
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. Engages health care professionals to take leadership in reducing unnecessary tests, treatments and procedures
CPSA.ca/polypharmacy
The College of Physicians and Surgeons of Alberta provide a summary on polypharmacy and its burden on geriatric patients
References
Robert L Kane et al. Essentials of Clinical Geriatrics 8th edition (2018)
Jeffrey B. Halter et al. Hazzard's Geriatric Medicine and Gerontology 7th edition (2016)
Jayna Holroyd-Leduc et al. Evidence Based Geriatric Medicine (2012)
Anderson et al (2015) Preventing High-alert Medication Errors in Hospital Patients. Am Nurs Today 10 (5)
PSNET (2015) Medication Errors. AHRQ Patient Safety Network
USFDA (2016) Strategies to Reduce Medication Errors: Working to Improve Medication Safety
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Goedecke et al (2016) Medication Errors: New EU Good Practice Guide on Risk Minimization and Error Prevention. DOI 10.1007/s40264-016-0410-4
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Kwan et al (2010) Polypharmacy: Optimizing Medication Use in Elderly Patients CGS Journal of CME Volume 4 (1)
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Mortazavi et al (2016) Defining polypharmacy in the elderly: a systematic review protocol. MJ Open (6)
Brandon et al (2014) 10 Rapidly Aging Countries. US News
The American Geriatrics Society (2012) Beers Criteria Update Expert Panel. American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc 60:616-31
Sera LC et al (2012) Pharmacokinetics and pharmacodynamics changes associated with aging and implications for drug therapy Clin Geriatr Med 28:273-86
Hovstadius B et al (2013) The impact of increasing polypharmacy on prescribed drug expenditure-a register-based study in Sweden 2005-2009. Health Policy. 109:166–74
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Lavan et al (2016) Predicting risk of adverse drug reactions in older adults. Ther Adv Drug Saf Vol. 7(1) 11-22
Jokanovic et al (2016) Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals. Journal of Eval in Clinical Practice
Garfinkil et al (2015) Routine deprescribing of chronic medications to combat polypharmacy. Ther Adv Drug Saf 6(6) 212–233
Marengoni et al (2015) Best Practices for Drug Prescribing in Older Adults: A Call for Action. Drugs Aging 32:887–890