Online Tool Helps Reduce Medications in Elderly

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Many people start taking a long-term prescription medicine sometime during adulthood. A particularly common one is medication for treating high blood pressure, which many people start taking as early as their 30s. As people get older, often more medical problems arise with more specialist doctors seeing the patient and adding more medications to treat the various conditions. Not only is this expensive and potentially wasteful healthcare spending; more importantly, this polypharmacy is risky and can lead to unintended adverse effects.

For example, an elderly member of my family would lose consciousness and fall unexpectedly. This problem was so severe that he had to give up golfing, which was his favorite and really only physical activity. He wound up being taken to the hospital in an ambulance on several occasions because of losing consciousness. I have a PhD in pharmacology and suspected he was having a problem with his blood pressure. When I reviewed his medicines, he was taking 3 different medications that reduced blood pressure either as a main effect or as a side effect. These different medications had been prescribed by 3 different doctors, and only one was intended to treat his high blood pressure. I went with him to the doctor and reviewed the medications, pointing out the issue. Ultimately, the doctors decided that 2 of the medications were unnecessary. He stopped taking those, and the falling stopped. His problem was medication-induced hypotension: His medicine made it so that his blood pressure would drop too low, causing him to lose consciousness.

Not everyone is lucky enough to have a pharmacologist or a pharmacist in the family to review medications and their mechanisms of action and their intended and unintended effects. Fortunately, there is an online tool that has been tested in a clinical trial, results from which show its effectiveness. The tool is called MedSafer and is intended to help physicians and pharmacists identify opportunities to reduce the number of prescription medications taken by people older than 65. A second larger trial is underway to evaluate the benefit of MedSafer in reducing adverse drug events in the elderly after discharge from a hospital. It is important to note that MedSafer generates a report with a list of medications that may be appropriate for discontinuation. This list represents a starting point for evaluation by the clinical team. It is not expected that all of the deprescribing opportunities will be appropriate at the time of treatment in the acute care hospital setting. Instead, the report is intended to provide the clinical team with valuable information that can guide patient care regarding potentially inappropriate medications.

“Quick access to up-to-date recommendations can help them replace or even stop certain inappropriate medications in a safe manner. It acts as a road map for the prescriber.”

Dr. Todd Lee, co-lead author of the study, scientist at the RI-MUHC and associate professor of Medicine at McGill University

MedSafer incorporates the deprescribing information from multiple sources, including American Geriatrics Society’s Beers Criteria®, the Screening Tool of Older People’s Prescriptions (STOPP) and Choosing Wisely. The report currently uses information about the patient’s medical history and the medications taken from electronic medical records. It does not integrate genetic data, which is also valuable in ensuring that patients are prescribed appropriate medications. For example the myopathy associated with some statins occurs in patients with a particular genetic variation in a single gene. It is not a common adverse effect of these medications. Rather, only those people with the gene variant are at risk of developing statin-induced myopathy.

I predict that eventually, not only will the patient’s medical history, symptoms, and medications but also the patient’s genetic information will be included in tools used to optimize and personalize drug treatment plans. Even without genetic information, MedSafer presents a valuable tool for physicians and patient care teams. Presently, this tool relies on electronic medical records and is developed for Canadian medical institutions. The studies support the development and application of such a tool to benefit the aging population in other countries as well.

“Performing a prescription check-up and stopping medications that might be problematic is important for seniors so they can maintain their independence, mobility, and cognition.”

Dr. Emily McDonald, first author of the study, scientist at the RI-MUHC and physician in the Division of General Internal Medicine at the MUHC

Clinical Trials

Reducing Post-discharge Potentially Inappropriate Medications Among Older Adults (MedSafer). https://clinicaltrials.gov/ct2/show/NCT02918058 (Accessed 10 October 2019)

Reducing Post-discharge Adverse Drug Events Amongst the Elderly: a Multi-centre Electronic Deprescribing Intervention. https://clinicaltrials.gov/ct2/show/NCT03272607 (Accessed 10 October 2019)

Related Resources

Safe and Efficient tool to Reduce Seniors’ Medication Overload. McGill University Health Centre. https://muhc.ca/news-and-patient-stories/news/safe-and-efficient-tool-reduce-seniors-medication-overload (Accessed 10 October 2019)

McDonald et al., The MedSafer Study: A Controlled Trial of an Electronic Decision Support Tool for Deprescribing in Acute Care. J. Am. Geriatr. Soc. 67:1843 – 1850 (2019). DOI: 10.1111/jgs.16040 PubMed

American Geriatrics Society 2019 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. J. Am. Geriatr. Soc. 67:674 – 694 (2019). DOI: 10.1111/jgs.15767  PubMed

O’Mahoney et al., STOPP/START Criteria for Potentially Inapproprite Prescribing in Older People: Version 2. Age Ageing 44:213 – 218 (2015). DOI: 10.1093/ageing/afu145 PubMed

Choosing Wisely, ABIM Foundation. http://www.choosingwisely.org/clinician-lists/ (Accessed 10 October 2019)

Choosing Wisely Canada. https://choosingwiselycanada.org/recommendations/ (Accessed 10 October 2019)

C. L. Kniffin, SOLUTE CARRIER ORGANIC ANION TRANSPORTER FAMILY, MEMBER 1B1; SLCO1B1. OMIM https://www.omim.org/entry/604843 (Accessed 10 October 2019)

Carr et al., SLCO1B1 Genetic Variant Associated with Statin-Induced Myopathy: A Proof-of-Concept Study Using the Clinical Practice Research Datalink. Clin. Pharmacol. Ther. 94:695 – 701 (2013). DOI: 10.1038/clpt.2013.161. PubMed

Canestaro et al., Genetic Factors Affecting Statin Concentrations and Subsequent Myopathy: A HuGENet Systematic Review. Genet. Med. 16:810 – 819 (2014). DOI: 10.1038/gim.2014.41

Cover details

Cite as: N. R. Gough, Online Tool Helps Reduce Medications in Elderly. BioSerendipity (11 October 2019)
https://www.bioserendipity.com/online-tool-helps-reduce-medications-in-elderly/

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