Scientific Medication Reduction Improves Quality of Life in Old Age

Source: Life Times

Author: Wang Zheng, Associate Chief Physician, Department of Geriatrics, Peking University Third Hospital

As people grow older, the medicine boxes of many elderly people are filled with antihypertensive drugs, hypoglycemic drugs, lipid-lowering drugs and other medications. Statistics show that more than 30% of the elderly in China take more than 5 kinds of drugs every day. Some elderly people even blindly believe in health supplements, making polypharmacy a normal state for the elderly to manage chronic diseases. There are three main reasons for this phenomenon: First, multiple coexisting chronic diseases require control with multiple drugs, and traditional treatment is accustomed to the logic of "identifying problems and adding new medications", which to a certain extent ignores the decline in metabolic function caused by aging and the higher risk of drug accumulation in the body. Second, the "prescribing cascade" leads to the use of one drug to prevent or treat the side effects of another drug. Third, medication inertia: long-term medication without regular reassessment results in continuous accumulation of unnecessary drugs. However, the state of being a "chronic medicine taker" hides hidden risks: the more types of drugs a person takes, the higher the probability of adverse drug reactions and drug-drug interactions.

Recently, the British Geriatrics Society released the Guidelines for the Reassessment of Polypharmacy in Older Adults, which systematically put forward the concept of "negative prescribing" for the first time, that is, reducing the medication burden for the elderly through scientific drug tapering. The guidelines clearly point out that the degree of frailty should be taken as an important reference for medication management, and drug reduction should be prioritized for elderly people with moderate to severe frailty. Frail elderly people have low drug tolerance, and excessive medication is prone to cause complications such as impaired liver and kidney function. Therefore, the key to negative prescribing is to regularly review the medication list: distinguish essential drugs for treating acute diseases, optional drugs for long-term prevention, and high-risk drugs that easily cause hazards, so as to achieve the goal of reducing medications without compromising therapeutic effects through individualized assessment, multidisciplinary consultation and post-discontinuation monitoring.

Many people hold the mindset that "taking medicine is treating illness", so they believe that reducing medication will aggravate their condition and thus resist drug reduction. In fact, scientific negative prescribing can reduce drug-related harm. For example, the combined use of anticoagulants and some traditional Chinese medicines with blood-activating ingredients will increase the risk of bleeding, in which case the use of such traditional Chinese medicines should be reduced as appropriate. At the same time, precise drug reduction will not undermine the therapeutic effect. For example, for elderly people with advanced dementia, appropriately relaxing the blood glucose control target and reducing related medications can not only avoid the risk of hypoglycemia, but also prevent blood glucose from getting out of control. The core of this practice is to evaluate the "net benefit" of each drug to ensure that the core treatment is not affected.

Negative prescribing does not deny the value of drugs. Its essence is to return to the "people-centered" concept, carry out stratified management according to the health status of the elderly, and increase the weight of quality of life while controlling risk factors and symptoms.

The clinical application of negative prescribing is mainly divided into four steps: comprehensively reviewing the medication list to screen out suspicious drugs; evaluating the feasibility of drug discontinuation to avoid withdrawal reactions; making joint decisions by doctors and patients to eliminate concerns; conducting regular reexaminations after drug discontinuation and relying on a multidisciplinary team to ensure safety.

Meanwhile, it is recommended that the elderly follow five principles: bring a medication list when visiting a doctor; take medicine at a fixed time with the help of pill organizers and alarms; confirm the drug name and shelf life before taking medicine; inform the doctor immediately if an adverse reaction is suspected; regularly clean the medicine box to screen out expired drugs.

The promotion of negative prescribing has very broad application value. Although it faces difficulties such as doctors' "fear of taking responsibilities" and the elderly's "fear of disease recurrence", these obstacles can be solved through professional training and popular science education.

Disclaimer: The information in this article is for popular science reference only and does not constitute medical diagnosis advice.