Decreasing Medication Burden in the Elderly Improves Quality of Life

A new study describes a systematic approach to the discontinuation of multiple medications in elderly community-dwelling patients.

Researchers at the Shoham Geriatric Medical Center (Pardes Hana, Israel) and the University of Otago (Christchurch, New Zealand) developed the Good Palliative-Geriatric Practice algorithm for drug discontinuation as a tool for reducing polypharmacy and improving mortality and morbidity in nursing home inpatients. The algorithm was applied to a cohort of 70 community-dwelling older patients as a means to identify recommended drug discontinuations. The mean age of the 70 patients was 82.8 years; 61% of them had 3 or more comorbidities, and 26% had 5 or over comorbidities. The mean follow-up period was 19 months, and the researchers recorded the success rates of discontinuation, morbidity, mortality, and changes in health status.

The researchers reported that at the beginning of the study, the participants used a mean of 7.7 medications. The protocol indicated that discontinuation was recommended for 311 medications in 64 patients, representing 58% of the drugs, a mean 4.4 drugs per patient overall, and 4.9 per patient who underwent discontinuation. Of the discontinued drug therapies, 2% were restarted because of recurrence of the original indication. When taking into consideration nonconsent and failures together, successful discontinuation was achieved in 81%. Ten elderly patients (14%) died after a mean follow-up of 13 months, with the mean age at death of 89 years. No significant adverse events or deaths were attributable to discontinuation, and 88% of patients reported global improvement in health. The study was published in the October 11, 2010, issue of Archives of Internal Medicine.

"Polypharmacy and inappropriate medication use is a problem in elderly patients, who are more likely to experience adverse effects from multiple treatments and less likely to obtain the same therapeutic benefit as younger populations,” concluded co-authors Doron Garfinkel, M.D., and Derelie Mangin, M.D., of the geriatric-palliative departments. "It is feasible to decrease medication burden in community-dwelling elderly patients.”

Polypharmacy is the use of multiple medications by a patient, in particular when too many forms of medication are used, when more drugs are prescribed than is clinically warranted, or even when all prescribed medications are clinically indicated, but there are too many pills to take (pill burden). The most common results of polypharmacy are increased adverse drug reactions, drug-drug interactions, and higher costs.

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Shoham Geriatric Medical Center
University of Otago