Deprescribing: Polypharmacy in Nursing Home Residents
Deprescribing: Polypharmacy in Nursing Home Residents
As the population ages, the health care system is challenged with an increasing burden of chronic diseases and rising prescription expenditures. Reducing polypharmacy should be a priority of clinicians working in nursing homes. At every patient visit, the clinician should engage in a process of evaluating each medication for its utility, taking into consideration such factors as patient's life expectancy, care goals, and length of time until benefits take effect with preventive medications. The 10-step discontinuation guide by Scott et al can serve as a tool to help clinicians detect medications that are high risk or no longer necessary.
Deprescribing medications in nursing home residents requires a team-based approach involving physicians, nurse practitioners, pharmacists, and nurses. Clinicians should enlist the collaboration of nursing home staff in the deprescribing process. Discontinuing a medication should involve proper planning, communicating, and coordinating with the patient and nursing staff. Reducing unnecessary or high risk medications can also decrease nursing time spent on administration. Nursing staff can help monitor the patient for beneficial or harmful effects from tapering/stopping medications. Patients and families can be educated about the dangers of polypharmacy to help them understand that a medication may be stopped if it is causing harm or no longer benefits the resident. In addition, patients and families can be informed that stopping unnecessary medications can reduce costs. Although deprescribing can be a time-consuming process, it can lead to significant benefits for the individual and decrease overall health care expenditures for society.
Discussion and Policy Implications
As the population ages, the health care system is challenged with an increasing burden of chronic diseases and rising prescription expenditures. Reducing polypharmacy should be a priority of clinicians working in nursing homes. At every patient visit, the clinician should engage in a process of evaluating each medication for its utility, taking into consideration such factors as patient's life expectancy, care goals, and length of time until benefits take effect with preventive medications. The 10-step discontinuation guide by Scott et al can serve as a tool to help clinicians detect medications that are high risk or no longer necessary.
Deprescribing medications in nursing home residents requires a team-based approach involving physicians, nurse practitioners, pharmacists, and nurses. Clinicians should enlist the collaboration of nursing home staff in the deprescribing process. Discontinuing a medication should involve proper planning, communicating, and coordinating with the patient and nursing staff. Reducing unnecessary or high risk medications can also decrease nursing time spent on administration. Nursing staff can help monitor the patient for beneficial or harmful effects from tapering/stopping medications. Patients and families can be educated about the dangers of polypharmacy to help them understand that a medication may be stopped if it is causing harm or no longer benefits the resident. In addition, patients and families can be informed that stopping unnecessary medications can reduce costs. Although deprescribing can be a time-consuming process, it can lead to significant benefits for the individual and decrease overall health care expenditures for society.
