Many people, particularly older people, begin taking a drug or group of drugs to address a particular ailment or condition. Unfortunately, the path of least resistance for both the prescriber and the patient is to maintain the drug regimen without questioning whether the prescription is still necessary, should be reduced or could possibly be harmful.
All drugs have side effects and have the potential to cause more harm than good. Again, this applies particularly to older patients, as they respond to and handle drugs differently. Older patients tend to be more sensitive to side effects and are less able to eliminate drugs from their bodies.
Polypharmacy also comes into play more with older adults, with many taking five or more drugs, some to address the side effects of other drugs. One study estimates that half of older adults are taking at least one potentially inappropriate drug.1 All this flies in the face of the fact that polypharmacy “is associated with increased risk of poor outcomes.”2-3
Even with the massive number of people taking multiple drugs with multiple side effects, the term deprescribing wasn’t coined until 2003. This is a further testament to the unbridled prescription-based philosophy that is the medical model.
Researchers and some medical providers are beginning to take a serious look at how to implement planned and supervised processes of deprescribing that will reduce or eliminate the dose that may be causing harm or is no longer providing a significant benefit. Not surprisingly, most guidelines that recommend drugs as a therapy are silent on the topic of when and how to deprescribe them.
A recent study “found that deprescribing antihypertensive medication was associated with less cognitive decline, particularly among those with dementia.”4 in addition to antihypertensive drugs, other drug classifications that also have studies showing a benefit from deprescribing include:2
- Anticholinergics – drugs used for gastrointestinal, urological and respiratory conditions
- Antihyperglycemics – for treating diabetes by reducing blood sugar levels
- Proton-pump inhibitors – to reduce the amount of acid produced in the stomach
- Psychotropics – which include antidepressants, anti-anxiety medications, stimulants, antipsychotics and mood stabilizers
While chiropractic is a profession that does not include the use of drugs (or surgery), the growing focus on deprescribing gives every chiropractor an opportunity to be more proactive in their efforts to reduce the drugs their patients are taking. Simply asking your patients when they last had a conversation with their medical provider to review the necessity of the drugs they take is a great start and can result in improving the health for your patients.
The more patients question the continued use of their drugs, the more medical providers may reconsider their necessity and perhaps even be more likely to reduce or eliminate their use.
References
- Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med, 2015;175(5):827-34.
- Chua S, Todd A, Reeve E, et al. Deprescribing interventions in older adults: An overview of systematic reviews. PLoS ONE, 2024;19(6):e0305215.
- Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf, 2014 Jan;13(1):57-65.
- Jing B, Liu X, Graham LA, et al. Deprescribing of antihypertensive medications and cognitive function in nursing home residents. JAMA Intern Med, 2024;184(11):1347-1355.
