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Clinician Article

Drug cessation in complex older adults: time for action.



  • van der Cammen TJ
  • Rajkumar C
  • Onder G
  • Sterke CS
  • Petrovic M
Age Ageing. 2014 Jan;43(1):20-5. doi: 10.1093/ageing/aft166. Epub 2013 Nov 12. (Review)
PMID: 24222659
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Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 7/7
    Newsworthiness - 6/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 7/7
    Newsworthiness - 6/7
  • Geriatrics
    Relevance - 6/7
    Newsworthiness - 6/7
  • Hospital Doctor/Hospitalists
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 6/7
    Newsworthiness - 5/7

Abstract

BACKGROUND: general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.

OBJECTIVES: to identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.

METHODS: electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged =65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.

RESULTS: we selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.

CONCLUSION: little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

A very useful article demonstrating what we do and do not know about reducing medications in complex seniors. The authors did not comment on what was to be learned from the articles they did not include.

General Internal Medicine-Primary Care(US)

Interesting review of a common problem. It gives some guidance for PCPs dealing with complex older adults taking several agents. It's fascinating that the withdrawal of drugs in the face of delirium has not been well studied! Certainly, this is an opportunity for further research.

Geriatrics

As a geriatrician, I find drug cessation one of most discussed topis over the last decades. The results of this systematic review give us a clear picture of evidence based approach on this topic.

Internal Medicine

Interesting data, not clear about the methodology: is it really a systematic review?

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