Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic

Abstract

Deprescribing aims to reduce polypharmacy, especially in the elderly population, in order to maintain or improve quality of life, reduce harm from medications, and limit healthcare expenditure. Coronavirus disease (COVID-19) is an infectious disease that has led to a pandemic and has changed the lives many throughout the world. The mode of transmission of this virus is from person to person through the transfer of respiratory droplets. Therefore, non-essential healthcare services involving direct patient interactions, including deprescribing, has been on hiatus to reduce spread. Barriers to deprescribing before the pandemic include patient and system related factors, such as resistance to change, patient's knowledge deficit about deprescribing, lack of alternatives for treatment of disease, uncoordinated delivery of health services, prescriber's attitudes and/or experience, limited availability of guidelines for deprescribing, and lack of evidence on preventative therapy. Some of these barriers can be mitigated by using the following interventions:patient education, prioritization of non-pharmacological therapy, incorporation of electronic health record (EHR), continuous prescriber education, and development of research studies on deprescribing. Currently, deprescribing cannot be delivered through in person interactions, so virtual care is a reasonable alternative format. The full incorporation of EHR throughout Canada can add to the success of this strategy. However, there are several challenges of conducting deprescribing virtually in the elderly population. These challenges include, but are not limited, to their inability to use technology, lack of literacy, lack of assistance from others, greater propensity for withdrawal effects, and increased risk of severe consequences, if hospitalized. Virtual care is the future of healthcare and in order to retain the benefits of deprescribing, additional initiatives should be in place to address the challenges that elderly patients may experience in accessing deprescribing virtually. These initiatives should involve teaching elderly patients how to use technology to access health services and with technical support in place to address any concerns.

Non-pharmaceutical interventions during the COVID-19 pandemic: A review

“…While the large majority of articles provide a general outlook to a specific topic, some draw from a specific context. In fact, we find comments focused from observations in USA [253] , [254] , [255] , [256] , [257] , [258] , in Italy [259] , [260] , [261] , in Canada [262] , [263] and the UK [264] , [265] . We have then articles that focus on Africa [266] , China [267] , Ethiopia [268] , France [260] , Poland [269] , Taiwan [270] , Vietnam [271] , South Korea [272] and Singapore [273] .…”

“…The second, the topics and references. Category Topic and references Change to medical practice Mental health care [254] , [257] , [261] , [273] , [274] , [275] ; Emergency care [276] , [277] ; Substance abuse [253] , [263] , [278] , [279] , [280] ; Oncological care [264] , [281] Health care practices [255] , [259] , [262] , [282] , [283] , [284] ; Pediatric care [283] , [285] Other care [256] , [260] , [268] , [286] , [287] , [288] Modeling Modeling approaches [28] , [265] , [289] , [290] , [291] , [292] , [293] ; Transmission dynamics [294] , [295] , [296] , [297] , [298] Mobile phone data [29] ; estimation [258] Effect of NPIs Effects on: children ...…”

“…This is the largest group of comments and/or perspectives. We find articles focused on a range of medical specialities: mental health care [254] , [257] , [261] , [273] , [274] , [275] , emergency care [276] , [277] , substance abuse [253] , [263] , [278] , [279] , [280] , oncological care [264] , [281] , health care practices [255] , [259] , [262] , [282] , [283] , [284] , pediatric care [283] , [285] , and other care [256] , [260] , [268] , [286] , [287] , [288] .…”

Deprescribing in older adults during COVID-19 pandemic; Opportunity or risk?

“…We have read with pleasure and attention the article “Barriers to conducting deprescribing in the elderly population amid the COVID-19 pandemic” by Elbeddini and colleagues recently published in Research in Social and Administrative Pharmacy. 1 In this very interesting and topical research, the authors analyzed deprescribing barriers, especially in elderly population, prior and linked to SARS-Cov2 infection.…”

“… 2 The COVID-19 pandemic underscores the relevance of continuous prescriber education and development of research studies on deprescribing. 1 …”