Deprescribing in Older New Zealanders

Abstract

Polypharmacy, the prescription of five or more medicines, is an emerging worldwide health concern. When older people are prescribed five or more medicines, they are susceptible to a wide variety of negative health consequences, including an increased risk of developing adverse drug events, drug interactions and falling. In specific, medicines with anticholinergic and sedative properties such as sedatives, antidepressants and antipsychotics, have been associated with both the cognitive and physical functioning decline of older people.

New Zealand has an exponentially ageing population and therefore issues pertaining to polypharmacy and appropriate prescribing are becoming more imminent. This thesis aims to explore issues related to prescribing in older people from the perspective of health professionals who care for them in everyday clinical practice (i.e. General practitioners and registered nurses).

Learning more about the challenges related to prescribing in older people, and administering medicines to older people in the residential care setting would enable us to better understand how to best implement deprescribing, in a safe and efficient manner.

Exploring GP and RN perspectives on deprescribing highlighted several existing challenges pertaining to time constraints, healthcare policies, reimbursement schemes and access to easy-to use guidelines that can empower health professionals to stop medicines that they believe are no longer providing benefit to their patient(s).

The findings of the pharmacist-led deprescribing feasibility study we implemented supports existing research that deprescribing has many associated benefits and is in fact feasible to implement, within the New Zealand healthcare system. Benefits including a reduction in residents’ pill burden, reported adverse drug events, depression and frailty scores were amongst the noted benefits after six months of deprescribing anticholinergic and sedative medicines. This further solidifies that deprescribing can be an effective and safe way to rationalise and optimise older people’s medication use.

Future work is required to determine how deprescribing can be implemented on a larger scale and can be incorporated into existing New Zealand healthcare policies.