By Dr. Cara Tannenbaum
Nowadays, it seems as if there is a pill for every symptom, big or small. Medications can relieve symptoms, cure illnesses and even prolong life. Not surprisingly, two-thirds of Canadians over the age of 65 years currently take at least five prescription drugs, while almost one-third take 10 or more.
However, few people realize that, as we age, our bodies become more sensitive to the effects of medication. Drugs are not eliminated as quickly as when we were younger. This increases the risk of harmful effects, such as drug interactions, falls, fractures, memory problems, premature loss of independence and even hospitalizations and death. Furthermore, the risk of such harmful effects increases when you take more medications.
It is alarming that 40 per cent of Canadians over the age of 65 years take a medication that is considered unnecessary or potentially risky for seniors. Examples of risky medications include sleeping pills, proton-pump inhibitors for acid reflux (when used long term) and antipsychotics for insomnia and dementia. Opioids, which are often used to treat chronic non-cancer pain, are another class of medications that might not be safe, as they have been shown to increase the chance of falls, fractures and overdoses. And risky drugs are costly: Approximately $1.4 billion in taxpayer dollars is spent every year treating the health problems they cause in older adults.
The prescription cascade
Medication side effects are not always correctly identified as such, and new drugs might be prescribed to deal with symptoms caused by a medication that is already being taken. This is
called the “prescription cascade.” A common example is constipation caused by a prescribed pill, which is then treated with laxatives. The prescription cascade can cause an individual to be prescribed multiple unnecessary or even harmful medications.
Seniors are the victims of this phenomenon. Their heightened sensitivity to the harmful effects of treatments and their vulnerability to drug interactions, combined with the use of potentially harmful medications, has serious consequences. As a geriatrician, I advise individuals to try non-drug therapy to treat their symptoms whenever possible. It may take more time and effort, but the benefits pay off down the road in terms of safety and effectiveness.
Deprescribing is a solution
When too many medications are taken, deprescribing is a solution. Deprescribing is defined as the planned and supervised process of reducing or stopping medications that may no longer be of benefit or may be causing harm. The goal is to reduce the medication burden and harm, while maintaining or improving quality of life.
40% of Canadians over the age of 65 years take a medication that is considered
unnecessary or potentially risky for seniors.
What can I do?
Individuals and caregivers can help eliminate medication side effects by being aware of health changes, flagging them to their healthcare provider and asking: “Could this be caused by a medication?” Common drug side effects include balance or memory problems, an increased number of falls and unusual behaviours.
How can we ensure that our medications—or those taken by a loved one—are still beneficial and improving our health? The solution is simple: Make an appointment with a doctor, nurse or pharmacist for a complete medication review. Prescriptions should be revisited regularly. Our bodies and health are always changing, and what was good for us in the past might not be needed now. Ask your healthcare professional:
1 Why am I taking this medication?
Has your doctor suggested that you start a new medication? Can you not remember exactly why you are taking a medication? Ask questions!
Tracking medications can be difficult, so it is important to keep an up-to-date list of all your medications handy. Ask your pharmacist to print out a copy of your medication list, or visit the Canadian Deprescribing Network website (deprescribingnetwork.ca) to download and fill out a medication record. Don’t forget to include over-the-counter purchases and natural products,
as they can also cause side effects and interact with prescription drugs.
2 What are the potential benefits and harms of this medication?
Speak to your healthcare professional about the potential benefits and harms of a medication, and make sure to prioritize what is most important to you. Medications such as sleeping pills, opioids and some antidepressants can affect the memory or cause falls. They can also slow our thinking process, often without us realizing.
3 Is there an alternative treatment?
In many cases, your doctor will be able to suggest an effective alternative with fewer risks of adverse effects. These alternatives may be other, safer medications or non-drug treatments. For example, acid reflux can be effectively treated with lifestyle changes such as eating fewer fatty or spicy foods, quitting smoking and maintaining a healthy weight. If these changes can be achieved then proton-pump inhibitors may be unnecessary.
Another example of a risky medication for which there are safer alternatives is sleeping pills. Many older adults don’t realize that sleeping pills can increase the risk of falling and of having
a motor vehicle accident, and can also worsen your memory. Fortunately, a safer non-drug therapy called “cognitive behavioural therapy for insomnia” can help you to retrain your body
to sleep naturally and medication-free.
4 Can I stop or reduce the dose of this medication (i.e., deprescribing)?
Would you like to know if it is possible to stop one or more of your medications? Ask your healthcare professional if deprescribing is right for you. Some of your medications may need to be reduced gradually to avoid withdrawal symptoms.
5 Who do I follow-up with and when?
Make sure you know the next step. If the decision is made to deprescribe a medication, book a follow-up appointment to ensure your health remains stable. Your complete medication list
should also be reviewed regularly.
Spread the word about deprescribing to friends and family, advocacy groups and government representatives. Visit the Canadian Deprescribing Network’s website (deprescribingnetwork.ca) for resources on safe medication management.
And remember: Always consult a healthcare professional before stopping or changing the dose of a medication.
Dr. Cara Tannenbaum is a geriatrician at the Institut universitaire de gériatrie de Montréal and Director of the Canadian Deprescribing Network.