Poly-De-prescribing vs Polypharmacy - The Weapon to Fight an Iatrogenic Epidemic: An Overview

Abstract

This review will focus on the topic of de-prescribing, including factors which impede and promote its implementation, the attitudes of physicians and patients towards it, as well as the core recommendations of the International Group for Reducing Inappropriate Medication Use and Polypharmacy that were recently published as a position statement. Finally, I will delineate a comprehensive geriatric-palliative approach to inappropriate medication use and polypharmacy (IMUP) utilizing poly-de-prescribing-cessation of as many nonessential medications as possible. The overarching goal of this approach is minimizing harm, and improving quality of life in the twilight of life for many elderly patients. I will only briefly touch upon the problematic definitions of IMUP, the variety of their negative clinical consequences, and the key tools previously suggested for combating the epidemic, issues which have been extensively discussed and evaluated in past reviews.

Turkish inappropriate medication use in the elderly (TIME) criteria to improve prescribing in older adults: TIME-to-STOP/TIME-to-START

“…Aging is often associated with multiple comorbidities, geriatric syndromes, and the consequent multiple drug use and polypharmacy. The older adults are more prone to adverse effects of medications due to their decreased physiological reserves, the negative effects of the age-related comorbidities, increased vulnerability for geriatric syndromes, and higher number of drug use [1]. As the population ages, the adverse effects of drugs in the older adults emerge as a public health problem [2].…”

Inappropriate medication use and polypharmacy in older people

“…Inappropriate medication use and polypharmacy is widespread yet continues to receive precious little attention 12. And, despite countless people being affected, particularly in older populations, no general consensus exists on the best way to combat this insidious problem 23…”

“…These strategies seem to have missed the bigger picture, perhaps because they derive from a guideline based worldview in turn based on a single disease model, which posits that patients are largely homogeneous. This is incongruent with the reality of older populations, where heterogeneity is the norm and where there is no longer such a thing as natural clinical course of disease, owing to inseparable co-mingling of multiple diseases with multiple drugs 23…”

“…Geriatric palliative concepts such as these are systematically neglected by healthcare systems, which fuel vicious cycles of overdiagnosis leading to inappropriate prescribing 3. The number of specialists caring for a patient multiplies along with the drugs they prescribe, each specialist being primarily concerned with treating the disease for which he or she is responsible.…”

“…Although all players take solace in the immutable truth of up to date guidelines, the unaddressed knowledge gap remains. In the absence of adequate research evidence, however, we must not neglect the other two pillars of evidence based medicine: clinical expertise and patient values 3…”