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The Gerontological Society of America has published a report calling for deprescribing as a means of managing polypharmacy in the elderly.
Deprescribing is defined as the “the systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences”.
Several key factors can contribute to polypharmacy in older adults:
- An increasing complexity of health care delivery, irrespective of the national setting, leading to problems of coordination between caregivers, physicians, and patients;
- The rise of co-morbidities and chronic long-term illnesses as the population ages;
- The huge numbers of available pharmaceuticals and their widespread use;
- The construction of guidelines based on single diseases, randomized control trials of low external validity, and drugs untested in the older population;
- Marginalization and disempowerment of older patients, with the absence of shared decision-making; and
- A culture in Western societies that is expectant of medical intervention at all levels.
This address in the new Public Policy & Aging Report addresses ethical and policy issues related to deprescribing and explore the application of this approach in practice, including how to address barriers to deprescribing.