To address the growing problem of overprescribing for seniors, a new Canadian guideline is calling for routine medication reviews.
In Canada, roughly two in three adults age 65 or older take five or more medications. While often necessary, complex drug regimens can increase the risk of side effects and affect quality of life.
The study underpinning the guideline - co-led by researchers at McGill University and the University of Toronto and developed by an interdisciplinary panel of experts - aligns with federal legislation calling for a strategy on appropriate medication use.
"We have a significant issue with overprescribing in Canada and globally. Patients taking 10, 15 or even 20 medications are not uncommon" said co-lead author Dr. Emily McDonald, Associate Professor in McGill's Department of Medicine.
Complex drug combinations are rarely studied together and can interact in unpredictable ways, contributing to falls, confusion, bleeding complications and other effects that are often mistaken for normal aging.
As there has been little guidance for clinicians, medication reviews often happen only after a complication arises, she added.
A shift toward prevention
Drawing on evidence from more than 100 clinical trials, the guideline recommends annual medication reviews for adults 65 or older, particularly those taking five or more medications. The goal is to catch unnecessary or potentially harmful prescriptions and, where appropriate, safely reduce or stop them.
The authors also highlight the need for government support to help make these checkups more widely available through physicians, pharmacists and nurse practitioners.
What this means for patients
Patients don't need to wait for their health care provider to initiate a prescription checkup, said McDonald. Seniors taking multiple medications are encouraged to ask for one, using five key questions to guide the discussion.
"Patients should understand their medications and feel empowered to ask whether non-drug options are possible," said McDonald, who also directs the Canadian Medication Appropriateness and Deprescribing Network.
The network's Medication Review Service Finder can help users find publicly funded medication review services in their area.
About the study
"Screening for potentially inappropriate prescribing in primary care" by Emily McDonald, Nav Persaud and Aine Workentin et al., was published in Canadian Family Physician.
The guideline process was supported both through the Canadian Task Force on Preventive Health Care (funded by the Public Health Agency of Canada) and through the Canadian Medication Appropriateness and Deprescribing Network (CADeN; funded by Health Canada).
