In geriatrics, deprescribing has become a very popular term. Deprescribing is simply reducing a patient’s medication burden by reducing and discontinuing medications. This is often done as the potential long term benefits of medication dwindle as a patient’s life expectancy goes down. My favorite deprescribing resource is a list of algorithms that really allows you as a clinician to identify patients who may benefit and/or be able to reduce their pill burden. You can find these algorithms here @ Deprescribing.org
When deprescribing medications, you must recognize that reducing medications can be challenging. You will run into patients where reducing medications is not worth the risk. This is where the algorithms linked above can be used as a supportive tool to help you identify those patients that we can reduce medications and those that we shouldn’t.
Reviewing the indication for any medication you are looking to deprescribe is super important. If a patient on a PPI has Barrett’s esophagus or is at higher risk of GI bleed due to anticoagulation or NSAIDs, this may be someone that we have to leave that long term PPI on board.
In clinical practice, I see PPI’s get added on quite a bit for GI prophylaxis. This can be an appropriate use for PPI’s, but many clinicians fail to reassess that PPI when the risk goes away (i.e. the NSAID is discontinued, or the anticoagulant for DVT prophylaxis has run its course).
At deprescribing.org, they also have algorithms for antipsychotics, benzos, dementia medications, and diabetes medications. Definitely take the time to check out this resource. Even if you don’t routinely use these resources, they serve as good educational tools as to why you would or wouldn’t discontinue a medication.
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