It was while working in acute care at the McGill University Health Center that the epidemic of over-medication among older Canadians became evident to physician Emily McDonald.
“We were seeing old people coming in with fall fractures, hip fractures, delirium, confusion,” says Dr. McDonald. “And a lot of it could be pretty easily attributed to the drugs or combinations of drugs they were taking.”
Going through the list of prescription drugs they were taking, it was clear that many were not appropriate, she said. The diagnosis was an overload of prescriptions.
“This is a huge problem,” says Dr. McDonald, associate professor of medicine and director of the Clinical Practice Assessment Unit in General Internal Medicine at the McGill University Health Center.
“More than half of people over 65 take more than five drugs and when you look into long-term care – the most vulnerable people – they take at least 10 drugs a day.
About 10 percent of their hospital patients take 20 drugs, says Dr McDonald, who is also a scientist at the Center for Outcomes Research and Evaluation.
“Some people take 30 tablets a day. They don’t even have an appetite for their meal after taking their morning pills, ”she says. “Their brains are all foggy and cognitively it affects them.”
Raise awareness of over-medication
In 2015, healthcare leaders, clinicians, government policy makers, academics and patient advocates formed the Canadian Network for Deprescribing. The network works closely with the Canadian Institute for Health Information, a federal not-for-profit corporation, to raise awareness and work to eliminate overprescribing and ensure access to safer drug and non-drug therapies.
“Unfortunately, as we strive to try and target a 50% reduction, it’s really hard to change the way we use drugs,” said Justin Turner, co-director of the network.
For example, Dr Turner says sleeping pills are one of the most commonly prescribed drugs, more likely to cause harm than to provide benefit. One in 13 people benefit from sleeping pills, while one in six is likely to experience the effects, he says. This includes an increased likelihood of falls or cognitive impairment.
Research shows that driving the day after taking a sleeping pill can carry the same car crash risks as driving while intoxicated, notes Dr Turner, who is also an assistant professor in the Pharmacy School of Medicine. Montreal university.
He says that thanks to public awareness campaigns and health care providers, prescriptions for sleeping pills are starting to decline somewhat across the country.
Dr Turner mentions Denmark, which has taken a more stringent approach.
“If you’re over 70, where the risk of harm increases dramatically, you can get your driver’s license or your sleeping pills. You can’t have both, ”Dr Turner said of Scandinavian country politics. “It was the most effective policy in the world to reduce the use of sedatives, with a reduction of 20%. “
Cognitive therapy is often effective for sleep disorders, but in this country, sleeping pills are paid for by one budget and cognitive behavioral therapy or psychological therapy is paid for by another, he adds.
“It’s the same with opioids,” says Dr. Turner. “It’s easy to prescribe an opioid for back pain, for example, because it’s covered, while physiotherapy and treatment for it may not be covered. So what are you going to do for a patient who cannot afford physiotherapy? Well, we’ll give them medicine because it’s covered.
A similar problem leads to high use of antipsychotic drugs in long-term care facilities, he says.
Most provinces have joined an initiative by the Canadian Foundation for Healthcare Improvement to reduce the use of these drugs in long-term care. Dr Turner says there are success stories across the country and the focus is now on working with policy makers to scale those successes nationwide.
Industry statistics show that Canada spends $ 400 million per year on drugs classified as inappropriate and $ 1.4 billion per year on remedying the side effects of these drugs. In some cases, drugs snowball over time, renewing themselves even when they cease to be appropriate.
Most clinical trials also exclude the elderly, so their effect on the evolution of physiology in the elderly is unknown. Clinical trials also do not study drug interactions with other drugs. Add to that Canada’s siled health care system, with multiple health care providers, and there is no definitive system in place to review a patient’s prescription use.
A 2017 study by the Institute for Research on Public Policy (IRPP) found that, on average, two-thirds of Canadian seniors take five or more prescription drugs in a year, and one-quarter of them take 10 or more.
It has been estimated that up to half of these drugs were taken incorrectly or overprescribed, increasing the likelihood of side effects or drug interactions, according to the report.
How Holistic Health Care Can Help
A more integrated team health approach has proven to be effective, with doctors, dieticians, physiotherapists, pharmacists and a whole team working together on treatment, says Colin Busby, research director at IRPP
“It’s that design issue,” he says. “You need a centralized person who gets information every time a patient is prescribed something. It shows up somewhere on someone’s screen and they know that person is prescribed a drug, and they can assess it.
Manually, such an exam takes 15 to 20 minutes, which means most GPs don’t have the time, adds Dr McDonald.
She and her colleague at the Research Institute of the McGill University Health Center, physician Todd Lee, have developed an electronic tool called MedSafer that aims to fill the void. MedSafer automatically crosses medical history, medications, and safe prescribing guidelines for the elderly to flag intermediate or high risk medications and potential adverse interactions.
Too often, drugs are prescribed to treat the side effects of other drugs, she says. Or these side effects are simply attributed to aging.
“We just think dad’s memory is bad because he’s getting old,” she says. “We don’t realize that if you stop her bladder pill or her sleeping pill her memory might actually improve a bit. “
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