PLOS One: What Are Priorities for Deprescribing for Elderly Patients?

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

Hint, benzodiazepines!

Really good overview.

Ali

Okay, this is the paragraph that really stood out to me and if you add the z-drugs to this statistic, I think that the number of seniors on either z-drugs or benzodiazepines would be closer to 1 in 4, not 1 in 5.  Given that these drugs are absolutely contraindicated for seniors, this is mind boggling to say the least.

"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