PLOS ONE: What are the priorities for deprescribing in the elderly?

http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122246

Very interesting statistics on incidence of prescribing in Canadian seniors.

"The classes of drugs that ultimately emerged as priorities from the final rankings dealt with mental health, cardiovascular, gastroenterological, and neurological conditions.  Three of the five drug classes selected as highest priority dealt with mental health conditions.

Benzodiazepines stood out in the consensus with the number one ranking in all three waves and atypical antipsychotics also retained a high rank across the three rounds. Both of these medication classes appear on the Beers Criteria, and Delphi participants commented on both the potential for adverse events and the withdrawal effects of deprescribing.

Analysis of public drug program expenditures in Canada demonstrate that 21% of seniors had at least one claim for a benzodiazepine-type drug in 2009–2010 [53], despite recommendations to minimize their use due to risk of adverse effects [54] and the existence of effective approaches to reducing their use [55].

Given the prevalence of use, it’s not surprising that this group of medications consistently rank as the number one priority for deprescribing guidelines. While effective approaches to discontinuation exist, clinicians clearly still need assistance with negotiating changes with patients, finding non-pharmacologic approaches to manage symptoms and managing the process of tapering. While antipsychotic use is not as prevalent (5% of seniors in Canada having had a claim in 2009–2010) [53], concern over limited effectiveness for neuropsychiatric symptoms in dementia and potential adverse effects, including higher mortality with long-term use [56], is likely prompting clinicians desire for guidance in stopping these agents."

Ali

Just to add that the incidence of 1/5th of Canadian seniors on benzodiazepines did not include those on z-drugs.  If you add z-drugs to the mix (and zopiclone is the 7th most prescribed drug in my province, British Columbia) the incidence of benzo/z-drug subscribing is more like 1 in 4, I think.

Makes my blood boil.

Ali

Just to add that the incidence of 1/5th of Canadian seniors on benzodiazepines did not include those on z-drugs.  If you add z-drugs to the mix (and zopiclone is the 7th most prescribed drug in my province, British Columbia) the incidence of benzo/z-drug subscribing is more like 1 in 4, I think.

 

Makes my blood boil.

 

 

Ali

"...the incidence of benzo/z-drug subscribing is more like 1 in 4, I think."

Big money!  Ever visit the sitting room of a nursing home, where all the "residents" are wheeled to during the day for some social interaction?  Most are just sitting there zonked with their chins on their chests.  The rest are staring into space.

This is a great fear of mine, that somehow I'll end up like this, medicated against my will.  Planning to do my best to avoid this, at all costs.

Yes, sadly $ is the root of all evil.  Pharmaceutical companies hell bent on profits at the expense of patients.  Doctors who are happy to have a revolving door of the worried well, addicted to prescriptions that require monthly refills and a steady revenue stream.  Awful.

Makes me truly sad when I stop to reflect that not much has changed since Dr. Ashton sounded the alarm.

Ali