06-22-2022 Primetime Livnig - Flipbook - Page 10
10 A Special Advertising Section of Baltimore Sun Media Group | Wednesday, June 22, 2022
PREVENTATIVE AND
ALTERNATIVE WELLNESS
Deprescribing
and cognition
Research on prescription
use vital for patients
and physicians
By Margit B. Weisgal, Contributing Writer
I
n the world of health care, primary care physicians (PCPs) and general practitioners causing harm, or no longer be of benefit.
(GPs) are – or should be – the gatekeepers for their patients’ health and, ideally,
have the best overview of each one’s current state. This is important because, as we
age, we tend to develop a variety of health concerns and see multiple doctors, each of
whom may prescribe medications. The problem arises when no one looks at all the various prescriptions, plus over-the-counter medications and supplements, to see if there
are potential interactions between them or – even worse – when a patient continues
taking the pills when they are no longer required. This can increase the risk for adverse
outcomes. Then, if you add in any cognitive decline, the situation is fraught with danger.
For Dr. Cynthia M. Boyd, M.D., Ph.D.,
professor of medicine, epidemiology and
health policy and management and director, division of geriatric medicine and
gerontology at Johns Hopkins University
School of Medicine, these topics surrounding medication use are a focus of
her research. She recently participated
in a study titled Deprescribing Education
vs. Usual Care for Patients With Cognitive
Impairment and Primary Care Clinicians,
published in the JAMA Internal Medicine,
that questioned if educating patients and
PCPs could reduce polypharmacy, a term
used to describe when someone takes
five or more prescribed drugs.
“There is more research about depre-
scribing than ever before,” says Boyd.
“What we’re trying to do is figure out
which setting, which approach, will produce the best results in reaching both
patients and physicians. For this study,
we looked at the primary care doctor’s
office to see if that improved awareness
of this complex problem.”
Why the research is necessary
The reason for this push on deprescribing is that many medications are
potentially inappropriate for patients
over 65. According to Deprescribing.
org, “Deprescribing is the planned and
supervised process of dose reduction
or stopping of medication that might be
Deprescribing is part of good prescribing
– backing off when doses are too high or
stopping medications that are no longer
needed.”
Starting in 1991, geriatrician Mark
H. Beers and a panel of experts published a list of Potentially Inappropriate
Medications (PIMs) for use in older
adults. In 2011, responsibility and
maintenance of the list shifted to the
American Geriatrics Society. “The AGS
Beers Criteria, most recently updated in
2019, is an explicit list of PIMs that are
typically best avoided by older adults in
most circumstances or under specific
situations, such as in certain diseases or
conditions.”
More simply stated, the potential
risks of medications included on the AGS
Beers Criteria often outweigh the benefits; when possible, clinicians should
choose an alternative. The list is not
intended to override the experience and
judgment of the person prescribing the
medications.
“One of the reasons to review medications,” says Boyd, “is so they’re not
contributing to cognitive changes. As a
patient takes more drugs, the possibility
for problems increases dramatically. In
addition to drug interactions – when they
work against each other – and adverse
drug reactions, such as falls or instability, potentially inappropriate medications
can affect cognition, one consequence
no one wants.”
Other areas the researchers are
investigating include what medications
does the individual really need and how
do clinicians keep them on those safely.
Does the dosage need to be reduced?
Are there alternatives with fewer potential side effects? And how do we convince people to do an annual review of
what pills they should continue, start,
taper or stop? Many people don’t know
that in some cases they can reduce the
frequency or stop altogether.
“We’re also trying to increase clinician
awareness that their patients’ pills can
be deprescribed,” Boyd adds. “Patients
ask me all the time, ‘how come you don’t
know what meds I’m on?’ And in nine
cases of 10, when we pull information
from different pharmacy databases, we
find medications the patient is taking and
never told us about, or that show up, but
the person is no longer taking. Systems
aren’t set up to inform the right people of
what’s going on.”
All this means there is a need to
instruct the different stakeholders on the
ramifications of taking multiple medica-
Deprescribing and cognition,
continued on page 28