JCPH Researchers Call for an End to Overprescribing in the Elderly

The global demographic landscape is rapidly evolving, with individuals aged 65 and above accounting for 9.3% of the population in 2020, totaling 727 million. Projections indicate a doubling of this demographic to 1.5 billion (16%) by 2050, emphasizing the need to tackle healthcare challenges specific to the elderly, particularly the pervasive issue of overprescribing.

"We’re living in an era where the elderly population is rapidly expanding globally. The key to revolutionizing healthcare for older adults lies in prioritizing effective deprescribing practices,” explains Chelsey Ali, PharmD, of JCPH.  “As pharmacists, we have the transformative power to enhance the well-being of older adults and shape a more patient-centered healthcare landscape.”

Polypharmacy, the regular use of at least five medications, is prevalent among older adults and introduces significant risks. Compounded by age-related alterations in drug metabolism and sensitivity, complex medication regimens raise the likelihood of errors and non-adherence. This, in turn, contributes to adverse outcomes such as increased morbidity, elevated healthcare spending, and diminished quality of life in older individuals.

In response, researchers advocate for deprescribing as a strategic approach to mitigate polypharmacy-related risks. "We encourage institutions to participate in initiatives aimed at fostering greater awareness of deprescribing," states  Charlene Tugwete, PharmD.  Deprescribing involves identifying and discontinuing drugs where potential harms outweigh benefits, done under the supervision of a healthcare provider. 

The recent editorial, The Pharmacological Deprescription in Elderly Patients, authored by JCPH and Italian researchers and published in the Italian Journal of Medicine, the official journal of the Italian Federation of Associations of Hospital Doctors on Internal Medicine, contributes to the literature on overprescribing in the elderly. “Our editorial aims to emphasize tailored interventions for improved patient outcomes and the mitigation of risks associated with polypharmacy in the elderly population”  states Daniel Huang, PharmD. 

Exploring how to safely reduce medications in older adults, the authors carefully look at when it's appropriate and what challenges might come up. They also give practical advice to doctors on how to be more aware of when to stop medications. They point out the problems that both doctors and patients face, like worries about side effects and issues with the healthcare system.

Overall, the authors stress the need for providers to focus more on what each patient needs and to be aware of the risks that come with taking too many medications. Their goal is to make healthcare better and safer for older individuals.

"We need to rethink medication use in older adults to reduce risks,” Vittorio Maio, PharmD, MS, MSPH, JCPH professor and Stefano Del Canale, MD, PhD,  Italian primary care physician explained.  “By tailoring interventions and raising awareness, we can prioritize the well-being of older individuals."