Friday, 15 Feb 2019

You are here

Deprescribing to Battle Polypharmacy

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.

Disclosures: 
The author has no conflicts of interest to disclose related to this subject

Add new comment

More Like This

No Difference in Oral or IV Antibiotics for Bone & Joint Infections

Research from the NEJM shows that oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first six weeks for complex orthopedic infections.

There is considerable discussion whether complex bone and joint infections must be managed with prolonged intravenous antibiotics or if oral antibiotic therapy may suffice. 

2019: the Year of Price Hikes

In 2019 there have been numerous reports of higher drug pricing for many drugs.  Yesterday it was reported that the price of insulin drugs have more than doubled from 2012 to 2016.

Reuters reports that in the United States, the pricing on more than 250 prescription drugs have gone up.

Does Methotrexate Work in Giant Cell Arteritis?

There seems to be both hope and uncertainty regarding the use of weekly methotrexate (MTX) in giant cell arteritis (GCA) patients whom need to limit their glucocorticoid use. While well done clinical trials have shown no certain efficacy, data suggesting MTX benefits comes from small trials, anecdotes and clinical experience. 

Price of Drug Promotion Skyrockets

JAMA reports that health care advertising costs in the U.S. have almost doubled over the past two decades, surging from $17.7 billion in 1997 to at least $29.9 billion in 2016. (Citation source: https://buff.ly/2Rk8a9Q)

2018 Rheumatology Year In Review

This annual appraisal of hallmark moments, news and research articles from 2018 are gleaned from that published in RheumNow during the last year and filtered by other news sources and literature review.  The top 10 list herein is rooted in what rheumatologists should know and what will likely change their standards and practice in the future, if not 2019.