Drugs: Prescribing less is prescribing better?

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Drugs: Prescribing less is prescribing better? /></p><p class=“Deprescribing” should be an even more widespread practice, say health professionals in Quebec.

Medication issues are common among seniors, especially due to polypharmacy and inappropriate use antipsychotics.

“She's coming back to life!” “, “You resuscitated her”… Here are some of the comments collected following a pilot project aimed at reducing the list of medications prescribed to seniors in the Capitale-Nationale region in 2017. Given its success, the he initiative will be extended to all CHSLDs and seniors' homes in the province.

In Canada, three-quarters of people over the age of 65 take more than five medications, and one-quarter take more than ten, according to the Canadian Institute for Health Information. These drugs can cause serious side effects and, in many cases, the remedy becomes worse than the disease.

Nonagenarian, Louise Thériault took about twenty pills a day, in addition to two daily injections, says her daughter Esterina Palmieri, who took her to the hospital several times because of too high blood pressure.

A drug can be justified at one point in life and not at another, for a host of reasons, explains Linda Vaillant, executive director of the Association des pharmacists in Quebec health establishments.

In your fifties, chronic diseases can appear, for which medications are then prescribed, continues Ms. Vaillant.

Mid-sixties, you lose muscle mass, your kidneys and liver work less well, you forget to change the doses […], side effects set in, and the reflex is then to give a other medicine to counter them.

Linda Vaillant also cites the example of drugs against cholesterol. At 65, they are very relevant to avoid heart attacks and strokes […], but at 90, you have to ask yourself the question with muscle pain that requires analgesics. You can then take the painkillers and cholesterol medications off instead, because there is no longer the effect you wanted to have at 65.

In Canada, three-quarters of people over 65 take more than 5 medications, and one-quarter take more than 10, according to the Canadian Institute for Health Information. Most of the time, these medications are necessary, but they often cause significant side effects. This is why doctors prefer to prescribe less, but better. Report by Gabrielle Proulx.

Geriatrician Quoc Dinh Nguyen, epidemiologist and researcher at the University of Montreal Hospital Center (CHUM), also invites senior patients to have the list reassessed of their medications, as some treatments may become more harmful than beneficial.

As the number of drugs prescribed increases, the risk of drug interactions and adverse effects increases.

“Removing meds isn't complicated, it looks trivial, but it makes a big difference. »

— Dr Quoc Dinh Nguyen, geriatrician, epidemiologist and researcher at CHUM

Dr. Nguyen cites the widespread example of sleeping pills and drug treatments for anxiety. In Quebec, the rates of antipsychotic use among residents of certain CHSLDs vary from 40% to 60%.

Quebec also has the highest rate of antipsychotic prescription among people aged 65 and over in Canada, according to the data from the Department of Health and Human Services.

For depression and anxiety, we know that the first line is often psychotherapy, but since we do not have easy access in Quebec, we prescribe medication, summarizes the geriatrician.

In many cases, deprescribing helps the patient, he points out: It reduces hospitalizations and returns to the emergency room.

It is especially recommended for patients who have been taking the same medications for several years. We know better the side effects with hindsight, notes Quoc Dinh Nguyen.

According to Linda Vaillant, even if there is still a long way to go, a new model of pharmaceutical practice is spreading in Quebec. The promised hiring of 200 pharmacists in public and private CHSLDs under agreement by 2025 should contribute to this.

A better quality of life despite aging depends a lot on judicious management of medication, she concludes.

Based on information from Gabrielle Proulx

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