Advanced Applications of Home-Based Primary Care - Virtual Workshop-Deprescribing Algorithm

Deprescribing Algorithm

Pdf Summary

The document outlines guidelines for implementing a deprescribing algorithm, focusing on the challenges and best practices when managing medications in older adults. Key points include:<br /><br />1. **Physiological Changes with Aging**: Aging leads to changes such as decreased total body water, decreased muscle mass, increased body fat, and reduced organ function, all impacting medication effectiveness and safety. Pharmacokinetic differences in aging necessitate a case-by-case evaluation.<br /><br />2. **Inappropriate Medication Use**: Includes issues like wrong dosing, drug interactions, duplications, and inappropriate drug choices. Special attention is needed for patients recently hospitalized or those seeing specialists.<br /><br />3. **Tools for Deprescribing**: The Beers Criteria is highlighted as an essential tool. Developed by the American Geriatrics Society, it provides evidence-based recommendations on drugs to avoid in older adults, focusing on five categories of inappropriate medication use. Adjustments should be filtered through clinical judgment.<br /><br />4. **Steps to De-escalate**: This includes:<br />   - **Step 1**: Identifying and reconciling all medications and their indications.<br />   - **Step 2**: Reviewing the overall risk using tools like Beers/STOPP.<br />   - **Step 3**: Assessing each drug for continuation based on indication, part of a prescribing cascade, preventative value, or patient burden.<br />   - **Step 4**: Prioritizing which drugs to discontinue first based on harm and withdrawal ease.<br />   - **Step 5**: Implementing and closely monitoring the deprescribing process.<br /><br />5. **Tapering Medications**: Guidelines on tapering include halving doses, viewing discontinuation as a trial, and stopping one medication at a time to manage withdrawal events.<br /><br />6. **Medication-Specific Considerations**: Outlines considerations and recommendations for deprescribing benzodiazepines, antihypertensives, statins, warfarin, NSAIDs, and acid suppressants, particularly focusing on risks, benefits, and the necessity of tapering.<br /><br />7. **Summary**: Highlights the prevalence of unnecessary medications in patients over 65 and emphasizes using the Beers Criteria and STOPP/START algorithms to identify and discontinue unnecessary or inappropriate medications, while ensuring a tapering approach where abrupt stoppage is not advisable. <br /><br />The document presents a comprehensive approach to the safe and effective reduction of medication use among older adults, aiming to minimize adverse effects and improve patient outcomes.

Keywords

deprescribing algorithm

older adults

medication management

physiological changes

inappropriate medication

Beers Criteria

medication tapering

drug interactions

STOPP/START

patient outcomes