Table 14: General Steps to Deprescribing Step
Additional Insight
Educate the patient and caregiver
Explain the deprescribing process strategy, include instructions and monitoring parameters
Collaborate with other healthcare providers
Inform specialists, consult with clinical pharmacist, keep lines of community open
Regularly reassess the medication Ensure continuity of care and adherence to treatment plan for improved outcomes Monitor adverse effects and benefits Identify unusual responses and address them; stay connected to patient to ensure continuity of care Consider nonpharmacological alternatives Recommend lifestyle modifications, behavioral interventions, and other nondrug therapies such as acupuncture, mindfulness, and peer support Involve family and caregivers Ensure their support (many of them dispense medication) Recognize successes and adapts Acknowledge progress in medication changes and improve progress Stay educated and connected Share information with colleagues and team; consult with pharmacist and other experts to keep apprised of new protocols (Lee et al., 2022)
● Convulsions ● Hip fracture
For frail, vulnerable older adults, in particular those in facilities where they may receive medication for agitation or other behavioral disturbances or issues there are higher rates of prescribing antipsychotic medications (APMs) There is evidence, according to Lee et al. (2022), that patients in 25% of U.S. nursing homes are receiving antipsychotic medications, with high rates of side effects. These side effects include higher risk of hospitalization from the use of APMs, due to: ● Infection ● Somnolence ● Urinary incontinence
There is a higher risk of death among this cohort due to these medications. Deprescribing medications in this vulnerable population can improve outcomes but should only be done with proper monitoring and adherence
to guidelines and clinical oversight. Conceptually, deprescribing in a clinical environment is a paradigm shift that requires guidelines, compliance, and staffing committed to patient-centered care in all healthcare settings. Case study 4: Mr. Smith—Consequences of unchecked polypharmacy and hyperpolypharmacy Patient Profile ● Name : Mr. Smith
2. Cognitive impairment : ○ The number of medications overwhelms Mr. Smith. ○ He struggles to remember dosages, frequently misses them, and realized he has taken duplicate doses. ○ His cognitive decline is worsening, he has started to fall asleep during the day, is awake much of the night, and knows he is often confused. 3. Increased fall risk : ○ Some medications he takes can cause drowsiness or dizziness. ○ Mr. Johnson’s balance is compromised; he regularly falls when home alone. 4. Medication Nonadherence : ○ It is difficult for Mr. Smith to manage his medications, and he doesn’t ask for help. ○ Mr. Johnson occasionally forgets to take his pills. ○ Nonadherence worsens his physical and mental health. Impact of Hyperpolypharmacy 1. Diminished quality of life : ○ Mr. Smith feels overwhelmed and burdened by the amount of medication he has to take. ○ His social life is limited due to constant medication management and sleepiness. 2. Financial strain : ○ Purchasing numerous medications strains his budget. ○ Co-pays add up, affecting his overall perspective and financial well-being.
● Age : 75 years Medical History ● Hypertension ● Type 2 Diabetes ● Osteoarthritis ● Depression Scenario
Mr. Smith has been managing multiple chronic conditions for most of his adult life. His medication regimen has gradually expanded, with various specialists prescribing additional drugs. He also purchases over the counter medications as additional symptoms arise. Unfortunately, there has been minimal coordination among his healthcare providers. As a result, Mr. Smith is now experiencing the consequences of unaddressed polypharmacy and hyperpolypharmacy. Impact of Unaddressed Polypharmacy 1. Adverse drug reactions (ADRs ): ○ Mr. Smith takes 10 different medications concurrently. ○ Unchecked polypharmacy increases the risk of adverse drug events, including: ▪ Drug interactions: Some combinations may lead to toxicity or reduced efficacy. ▪ Side effects: Nausea, dizziness, and fatigue are common (which he frequently addresses with over-the-counter products).
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