When was the last time your doctor or pharmacist suggested that you consider stopping a medication?
It doesn't happen often enough, according to University of Alberta pharmacy researcher Dr. Cheryl Sadowski.
She's a leading Canadian advocate for deprescribing, a growing practice that involves regular review of the medications you're taking, and careful tapering of those deemed redundant or no longer beneficial.
Research by Sadowski and others shows that up to one in four older adults in Canada were taking 10 or more different classes of medication in 2021, even though it's known that this type of "polypharmacy" increases your risk of harmful drug interactions by eight times compared with taking two prescribed medications.
"We know that as we age, drug effects and drug tolerance can change, yet we're very slow to take people off medications. That's what we call clinical inertia," Sadowski says. "Then when people have safety issues like falling or confusion, they blame it on aging, but it's really the medication.
"We can do a better job of helping people age safely by only using medicines when there's really no other option."
And it's not only seniors who should be concerned. It can happen to children and adults too, particularly those with chronic conditions.
In honour of World Pharmacists Day Sept. 25, Folio asked Sadowski what we all need to know before approaching our health-care teams with our own list of medications.
Aging doesn't have to mean more pills
The term "deprescribing" was coined in 2003, and the research has been gaining momentum ever since, Sadowski says.
Successful deprescribing is when the total number of medications you take is reduced, your doses are lowered or your prescriptions are substituted for medications with fewer risks.
"It's a really critical reassessment," says Sadowski, a professor in the Faculty of Pharmacy and Pharmaceutical Sciences who also works weekly in a geriatric clinic.
"Patients just kind of accept that being on a lot of pills is part of aging, but it doesn't have to be," she notes. "In our clinic we take two hours to look at the patient's goals, their health considerations and all their medications."
Sadowski has been working with the Canadian Medication Appropriateness and Deprescribing Network since it was started in 2015, a resource for health-care providers and patients. She recommends patients visit the site to learn more about their medications and potential interactions. Other places to look include the Institute for Safe Medication Practices Canada,Deprescribing.org, the Canadian Medication Appropriateness and Deprescribing Network, and Choosing Wisely Canada.
The top three culprits
Sadowski flags three classes of medications as the most likely to be overprescribed or cause harmful side-effects: sleeping pills, heartburn medications and pain prescriptions.
Sleep medicines are among the top 10 medications given to seniors. They fall into a class of medicines known as "psychotropics" that affect the brain, and have been linked to harms including confusion, a higher risk of dementia and an increase in falls. Sadowski notes that Health Canada recommends these medicines as only a short-term, two-week intervention, yet many people keep taking them for years.
"We have over 200 studies related to harm with sleeping pills in older adults," Sadowski notes. "Within days of starting a sleep medicine, you're more likely to fall - and that risk continues as long as you take it."
