‘Are all these medicines necessary? A case for deprescribing in the elderly.

One of the goals of clinical therapy is to improve patient quality of life, however in some cases more harm is done than good. This is often the case of overtreatment and "too much medicine". overtreatment and polypharmacy "too much medicine " in the elderly with multiple chronic diseases have been shown to contribute greatly to serious negative effects such as adverse drug effects, falls, increased cost, frequent emergency department visits, hospital admission and on very severe cases, death. Older patients with co-morbidities are often loaded with too much medicine which is driven by strict adherence and reliance on clinical therapy guidelines most times. 

Most patients older than 70 years old with multiple chronic diseases such as hypertension and diabetes take upto six or more medicine where some of them are not relevant or are inappropriate. Take for instance,  a study conducted in a rural tertiary hospital in Nigeria by Dr.Fadare and colleagues shows that about one in four prescriptions had a potentially inappropriate medicine with non-steroidal anti-inflammatory nails (pain killers) being the major culprit followed by anti-histamines. Because aging leads to a change in the way the body affects the medicine (pharmaco-dynamics) and how medicine affects the body (pharmaco-kinetics), polypharmacy can increase the potential for side effects and drug-drug interactions.

In recent times, calls for de-prescribing as a means of optimising medication use and reducing overtreatment and it's adverse effects have garnered much support especially in developed countries such as Canada and Australia. Deprescribing refers to the planned act of tapering, stopping, withdrawing or discontinuing a medication that are not useful or may be causing some adverse effect to the patients. It is common sense to withdraw a medication if it is not effective and not needed any longer as well as when the risk outweighs the benefit. Deprescribing will require collaboration between the physician,  pharmacist and the patient in order to be successful. Whilst evidence for the beneficial outcome of deprescibing is growing,  it is advisable that the process of de-prescribing in the elderly should be initiated after a comprehensive medication review and in a cautious approach so as to avoid any undesirable effect of derescribing such as withdrawal symptoms.