Re: Too much medicine in older people? Deprescribing through shared decision making
I welcome Jansen and colleagues' article about deprescribing in older people (1). As a palliative medicine consultant, I often see examples of patients on inappropriate primary prevention medications, even as they approach the end of their life. Often these medications can be harmful at worst, and add to unnecessary medication burden at best. A prime example is statins at the end of life. Evidence shows that stopping statins in the context of advanced illness can improve quality of life (2).
A particular challenge for those attempting medication rationalisation at the end of life can be the previous information given to patients, and all clinicians should be aware of this. Some of my patients have previously declined to stop their statins because clinicians have told them they "should be on them for the rest of their life". Whilst well meaning at the initiation of therapy, a more realistic comment when starting new, long term therapies, with the aim to encourage compliance but also enlighten patients that there may come a sensible time to stop medications, might be "continue this until you and your doctor agree it is no longer helpful."
1) Jansen and Colleagues. Deprescribing in older people. BMJ 2016;353:i2893
2) Kutner et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life limiting illness: A randomised clinical trial. JAMA Intern Med 2015; 175(5): 691-700
Rapid Response:
Re: Too much medicine in older people? Deprescribing through shared decision making
I welcome Jansen and colleagues' article about deprescribing in older people (1). As a palliative medicine consultant, I often see examples of patients on inappropriate primary prevention medications, even as they approach the end of their life. Often these medications can be harmful at worst, and add to unnecessary medication burden at best. A prime example is statins at the end of life. Evidence shows that stopping statins in the context of advanced illness can improve quality of life (2).
A particular challenge for those attempting medication rationalisation at the end of life can be the previous information given to patients, and all clinicians should be aware of this. Some of my patients have previously declined to stop their statins because clinicians have told them they "should be on them for the rest of their life". Whilst well meaning at the initiation of therapy, a more realistic comment when starting new, long term therapies, with the aim to encourage compliance but also enlighten patients that there may come a sensible time to stop medications, might be "continue this until you and your doctor agree it is no longer helpful."
1) Jansen and Colleagues. Deprescribing in older people. BMJ 2016;353:i2893
2) Kutner et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life limiting illness: A randomised clinical trial. JAMA Intern Med 2015; 175(5): 691-700
Competing interests: No competing interests