Most of the time, when I ask a man or woman in their 90’s whether they feel they are taking too many tablets, the answer is yes! Equally, when I ask whether they would be interested in reducing the amount of medicine they are prescribed the answer is an even more emphatic, yes, please!
This is de-prescribing.
It isn’t randomly stopping medicines (as I have seen happen), and, it is not to do with saving money, although it does save money, but not usually from the pharmacy budget – I will explain.
In the UK we have a fantastic primary prevention service that aims to maintain the health and wellbeing of our population. It is perhaps not as great as Germany or Norway, but it’s pretty good.
The prescription of statins to lower cholesterol, blood pressure measurement and reduction, diabetes prevention schemes and so on, all combine with the Public Health message of more exercise and less fat.
The former is more successful as medicines tend to be done to people not with them.
‘Take this pill and see me in six months,’ kind of thing, rather than, ‘No more Burger King,’ which for some is harder to palate.
So, medicines are good, they work (not for everyone, even, most of the time, but that is for another day – this is the realm of ‘numbers needed to treat’).
When you are 50 with a raised blood sugar, blood pressure and cholesterol, the following prescription is probably what you want:
Atorvastatin 40mg once a day
Bisoprolol 5mg twice a day
Ramipril 5mg twice a day
Metformin 500mg twice a day
Amlodipine 5mg once a day
Gliclazide 80mg three times a day
… the list could, and often does go-on.
And this is all proven to reduce the risk of you experiencing a heart attack, stroke, diabetes or renal failure.
These drugs have all been with us for over 30 years, some, like Metformin were invented in the 1920’s.
The thing and, very much the point of de-prescribing is determining whether the medicine you took when you were 55 is right when you are 85 or 95.
Often it is right to continue.
If the beta-blocker has controlled your heart rate for 40 years, stopping might not be the thing to do.
Yet, if you are falling over or, you blood sugar is too low, or you are struggling to get enough calories into yourself because the pills make you feel sick, it is time to re-think.
This is de-prescribing.
The realisation that medicine ‘x’ is doing either nothing for you or, on occasion, more harm than good.
This is the cost saving – through maintaining wellbeing.
In stopping medicines that work for people in their 50’s but do harm to people in their 90’s we not only improve quality of life, we reduce harm – predominantly falls, but also other symptoms such as nausea, diarrhoea, dizziness, fatigue.
To re-iterate, it is not about saving money or somehow economising on older people, it is about adjusting treatments to match an individual’s changing life circumstances.
Anyone up for a little de-prescribing?
Ask your doctor…