Re: Deprescribing medication for frail elderly

This is an important issue when it comes to working in the geriatrics population [BCMJ 2014;56:436-441]. There is a tendency to continue to prescribe additional medication without careful evaluation of what the patient is on and whether it is still needed. Significantly untoward incidents can result from this polypharmacy and the drug interactions that ensue, at great cost to individuals, families, and the health care system.

When I trained as a family physician we learned well the lessons of monitoring medication use with flow sheets, at least one tool that can assist in preventing these disasters. Another was the home visit where a side trip to the patient’s medicine cabinet was a useful venture. We can still ask patients to bring in all the medication they are taking, remembering also to ask about all the non-medication substances they are taking.

This article reminded me of a study carried out in the early 1980s by a couple of medical students, a physician in a neighboring town, and me. In our personal care home we had a practice of reviewing medications with the charge nurse every 3 months, at which time we decided what needed to be continued or changed. The neighboring town did not have this practice. Not surprisingly, the average number of drugs taken on a daily basis in the neighboring personal care home was double what was being dispensed where I worked: something like six to seven versus three to four.

This article did address the lack of funding to support such reviews. Indeed, the morbidity and mortality involved with overprescribing, including expensive evaluations and hospital stays, costs not only the individual and his or her family, but also our health care system. For the well-being of our geriatric citizens, as well as our increasingly resource-stressed health care system, it would behoove our Ministry of Health to fund such regular reviews in personal care homes. Community patients can have this done on a regular basis as long as their physicians have a system set up to do this.
—Lorne Brandt, MD
Richmond