Sometimes less is more. Next time you see your doctor, ask about 'de-prescribing'—a supervised process of stopping medications that are no longer needed. This is something everyone should know about, especially older Australians.
The Problem of Polypharmacy
According to oncologist Ranjana Srivastava, 'Forty per cent of Australians over age 75 take five or more medications.' This phenomenon, known as polypharmacy, affects 80% of nursing home residents. As people live longer and see multiple specialists, the number of older people exposed to polypharmacy is rising.
One of Srivastava's patients, in his late 80s with advanced cancer, was taking an astonishing 17 pills a day at diagnosis. The medications included treatments for heart disease, diabetes, stroke, gout, reflux, and anxiety. When he developed cancer, new drugs were added. After hospital admissions, even more were prescribed. Eventually, he was taking 25 pills daily, leaving him feeling too full to eat and confused.
The Risks of Too Many Medications
The risk of an adverse drug event in elderly people increases from 13% for two drugs to over 80% for seven or more. An estimated 250,000 hospital admissions in Australia are medication-related, two-thirds potentially avoidable, costing taxpayers $1.4 billion annually. Srivastava notes that many drugs become irrelevant or harmful as patients age or their health changes.
For her patient, multiple antihypertensives were no longer needed due to weight loss and dizziness. The statin was useless given limited life expectancy. Blood thinners became risky alongside diabetes drugs that caused low blood sugar. Anxiety medication from decades ago was redundant, as were gout and reflux drugs. Most supplements were useless.
What Is De-prescribing?
De-prescribing is a structured, supervised process of stopping medications that are no longer necessary or beneficial. It requires better doctor-patient communication and shared understanding of care goals. For example, a fit golfer might benefit from robust heart failure management, but that would be harmful for a terminally ill cancer patient. Tight blood sugar control may be appropriate at 70 but not at 90.
New Guidelines and Tips
New Australian guidelines provide de-prescribing recommendations for the 100 most prescribed drugs, including when and how to safely stop them. Srivastava offers these tips for patients:
- Carry a list or take a photo of your current medications. Medical records vary, so the most reliable record is the one you bring.
- Ask your GP: What is this medication for? Do I still need it? What would happen if I stopped it? Is there a safe way to stop? Do I need to consult someone else?
There is also a free government scheme for people over 75 living at home or in residential care: the medication management review, initiated by a GP and conducted by a pharmacist. However, 95% of elders don't use it. Every eligible person should.
As Srivastava's patient discovered, de-prescribing can bring relief. 'Like him, there are hundreds of thousands of people for whom less could be more,' she writes. 'The next time you see your doctor, ask about de-prescribing.'
