Deprescribing medications
Deprescribing medications in the elderly involves a comprehensive approach that considers the overall health status, life expectancy, and goals of care for each patient. The process typically includes identifying potentially inappropriate, unnecessary, or harmful medications and planning deprescribing with the patient’s consent and involvement.
Common classes of drugs that are often targets for deprescribing include
- antipsychotics
- statins
- antihypertensives
- benzodiazepines
- proton-pump inhibitors
- nonsteroidal anti-inflammatory drugs (NSAIDs)
- COX-2 inhibitors
- acetylsalicylic acid.
Several tools and guidelines are available to aid in this process, such as the
- Anticholinergic Burden Calculator
- Beers List from the American Geriatrics Society
- deprescribing.org
- NSW deprescribing-tools
which offers specific guidelines and algorithms for deprescribing various medication classes including proton pump inhibitors, antihyperglycemics, antipsychotics, and benzodiazepine receptor agonists.
Regarding permissible levels of blood pressure (BP), cholesterol, and sugar in the elderly, the guidelines and research suggest the following:
- Blood Pressure:
- For patients over 60 years of age, the recommended target systolic blood pressure is generally less than 150 mm Hg. However, for those with a history of stroke or transient ischemic attack (TIA), or who are at high cardiovascular risk, a lower target of less than 140 mm Hg may be appropriate.
- Recent studies, such as those from SPRINT, indicate that for patients over 80 years of age with preserved renal function and cognitive status, a BP goal of less than 130/80 mm Hg can be considered, with more frequent monitoring and a shared decision-making approach.
- Cholesterol and Dyslipidemia:
- Specific cholesterol level targets for the elderly are not universally defined and may vary based on individual risk factors and overall health status. The management of dyslipidemia in the elderly often focuses on individualized treatment strategies considering the patient’s functional profile and the risks and benefits of lipid-lowering drugs.
- Blood Sugar:
- The management of diabetes in older adults often emphasizes individualized glycemic targets, balancing the benefits of stringent glucose control against the risks of hypoglycemia and other adverse effects. Specific targets may vary based on the patient’s health status, comorbidities, and life expectancy.
It is important to note that these guidelines are not strict rules but rather recommendations that should be adapted to each individual’s specific circumstances. In all cases, the management of hypertension, cholesterol, and diabetes in the elderly should involve careful consideration of the potential benefits and risks of treatment, with a focus on improving quality of life and functional status.