Vancouver Sun – Study aims to stem seniors' prescription drug intake
August 27, 2012
'Deprescribing' simplifies medication regimens to cut the risk of side-effects and improve quality of life
The first phase of a new multi-part research initiative at Richmond Hospital aims to tackle the issue of over-medication in seniors by looking to reduce the amount of drugs they take.
The study will mark the first instance in B.C. of a community, acute-care facility, performing the kind of clinical research usually done at larger hospitals.
"The fundamental basics for doing it is that the number of prescriptions older patients are taking is growing," said Dr. Scott Garrison, the new medical research director for Vancouver Coastal Health in Richmond. "It's a recognition that there's a problem with how we treat the elderly. Our primary motive is to improve their quality of life and independence."
Garrison is applying for grants to begin the project, which will involve enrolling Richmond patients in a study where they are randomly assigned to a method of minimizing their medication intake.
Participating physicians in the city will be asked to select patients for the study based on a prescription drug profile and whether they would be willing to reduce their dosage. Garrison said he will spend the next year determining which physicians will take part.
The process, called polypharmacy reduction, or simply "deprescribing," seeks to improve the patient's quality of life by simplifying medication regimens and cutting down the risk of drug side-effects that may result from taking bloated pill cocktails.
"As you increase medication, you exponentially increase the potential for side-effects," he said. "It happens to people of all ages, but the elderly are more susceptible."
The pilot phase in Richmond, which will last up to a year, will determine the optimal deprescribing plan and see if the trial design is workable for both patients and their doctors. The study hopes to reduce dosages of drugs like antidepressants, antipsychotics, pain medication and sedatives. If the trial is successful, Garrison hopes to expand the program and involve more than 200 physicians and 1,500 patients across the province. He is confident that the response to the trial will be favourable.
The over-medication of seniors in B.C. is a "huge issue," according to Dr. Gloria Gutman, professor emeritus at Simon Fraser University and research associate at the school's Gerontology Research Centre. Gutman sees two positive outcomes in Garrison's study.
"It's better for the patient and it's also good as a cost-cutting measure," she said. "Much of the yelling and screaming on increases in medical costs are the result of new technology and prescription medication. Drugs are a big driver."
Older people tend to treat every-thing the doctor says as gospel and do not question whether they need a particular drug or dosage, Gut-man said, which can lead to health complications.
"Drug interactions and illness that come about because of treatment is very common," she said. "When an older person presents symptoms of dementia or apparent memory loss, one of the first things a skilled geriatrician will do is look at their medication and ask, is this possibly the drugs talking?"
In some cases, multiple doctors treating a single patient do not have a complete picture of the individual's prescription drug history, she added. This can lead to something Garrison calls a prescribing cascade.
"You can have a drug that causes an unrecognized side-effect. Then you could end up having another drug pre-scribed to treat the side-effects of the first drug," he said. "There could be a lot of different adverse effects that prescribers are not aware of."
Gutman also suggested society's treatment of medication as "magic bullets" has led to increased prescription drug consumption among seniors.
"Not all of those medications work," she said. "You might be making people worse off than before. But the thing is, if they've been on a specific medication for years and years, you need to be careful you don't take them off suddenly (and force them onto a different drug)."
A report issued by the B.C. Minis-try of Health in December 2011 on the use of antipsychotic drugs in B.C. residential care facilities found a little over half of older residents are on some type of antipsychotic. About 85 per cent of patients in care units have been diagnosed with dementia or are otherwise confused or impaired and often the first reaction is to drug them, Gutman said.
"People are being zonked on antipsychotics," she said. "What blew our socks off is that the drugs being pre-scribed in B.C. (care facilities) are ones that have had warnings of adverse side-effects for some time. Some of them are off-label, which means it's a drug that's prescribed for another disease."