Word Watch: deprescribing (and frailty)

deprescribe picThe success of modern medicine has meant that the longer people live, the more managed conditions they will have.

In some circles, that’s known as “co-morbidities”; in the editorial in this month’s (March 2014) issue of Drug and Therapeutics Bulletin (DTB, a BMJ journal), it’s “multimorbidity.” (Editor’s note: Toe-MAY-toe, toe-MAH-toe.)

The editorial notes that multimorbidity has led to polypharmacy which can result in drug interactions.

One way to prevent drug interactions is to avoid “problematic polypharmacy” and practice “appropriate polypharmacy,” including “medicines optimization” which must include the notion of stopping some medications, or “deprescribing.”

“At worst, this can be the thoughtless termination of drugs on the basis of arbitrary thresholds such as age; at best, it involves identifying the point at which drugs are no longer providing a worthwhile benefit,” the DTB editors said.

“Many medicines are often continued beyond the point at which they are beneficial and may actually be causing harm. Yet this is an area with very little evidence and one of the most difficult decisions facing patients and prescribers is in agreeing when and how to stop.”

Among the messages of a King’s Fund report on polypharmacy, released last November (2013), was that when reviewing medications, “healthcare professionals … should always consider if treatment can be stopped and to recognize that ‘end-of-life’ considerations apply to many chronic diseases, cancer-related conditions and frailty,” the DTB editors said.

But they also noted that frailty is a term “we shall hear more of in the coming years as it moves from a poorly defined abstract concept to one that proves central to our notion of health in older age.”~TM

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