A TOUGH PILL TO SWALLOW

Too many older adults are taking medications where the likely harms outweigh the potential benefits. Is it time to start 'deprescribing'?

- Claire Sibonney

When he was younger, DeLon Canterbury, a pharmacist based in Durham, North Carolina, witnessed first-hand the harm some medications can do. His grandmother, in her 80s and suffering from dementia, was rapidly declining. She became more withdrawn and irritable, and frequently misplaced items like her glasses and dentures. Her condition forced her to leave her nursing home and move in with Canterbury's mother.

During a routine prescription refill, a pharmacist warned Canterbury's mother that one of the medications, an antipsychotic drug, was exacerbating her mom's dementia symptoms. "This medication comes with a Food and Drug Administration black box warning-the most serious kind of warning for any drug," Canterbury says. "It indicates that for dementia patients with behavioural problems, this drug can not only worsen their condition, but also increase their risk of death."

Patients like Canterbury's grandmother aren't unique; they highlight the risks of overmedicating, particularly among older adults. A significant portion of the population takes multiple medications, a practice known as 'polypharmacy' in Europe, polypharmacy rates among people ages 65 and older are between 26 per cent and 40 percent; nearly 20 per cent of Canadians ages 40 to 79 use five or more medications a month; 49 per cent of Indians aged 60 and above; and more than a third of Australians over 70 experience polypharmacy.

Emily McDonald, an associate professor of medicine at McGill University in Montreal and the scientific director of the Canadian Medication Appropriateness and Deprescribing Network, has seen firsthand the rise of excessive medication use. "The average number of meds that my patients take in internal medicine is 10, and that has increased just in the last 10 years. I've seen that number go up and up," she says.