In developed countries, it is estimated that approximately 30% of patients ages 65 and older are prescribed 5 or more drugs, and approximately 50% of patients in hospital, ambulatory or nursing home settings receive 1 or more unnecessary medications. Additionally, 47.3% of older adults reported using at least 1 over-the-counter (OTC) medication and 54.2% reported use of at least 1 dietary supplement in a study by Qato, et al.
Medicare Annual Wellness Visits (AWVs) provide an opportunity outside of problem-based visits for patients and providers to complete a global review of prescribed medications. To optimize medication management for an AWV, it may be helpful to focus on reducing medication burden and deprescribing dietary supplements, OTC medications, and high-risk or preventive-care medications. The chart below lists some key medication interventions to consider:
The above considerations are aimed at helping providers make quick and effective AWV interventions to reduce polypharmacy and patient pill burden; minimize medication-related preventable adverse events, e.g., over-sedation, bleeding events, cognitive impairment; and discontinue high-risk medications while providing safer alternatives where appropriate.
Additional resources
medstopper.com – Helps prioritize agents to deprescribe based on an entered medication list.
deprescribing.org – Contains deprescribing guidelines and algorithms under its “Resources” tab.
acbcalc.com – Helps identify anticholinergic agents in a patient’s medication list.
References:
- Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015; 175(5):827-834.
- Qato DM, Alexander GC, Conti R, et al. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA. 2008; 300:2867-2878.