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Strategy needed on seniors’ meds

VANCOUVER—Canada urgently needs a national strategy to ensure seniors are prescribed appropriate medications because the cost of giving them the wrong drugs has reached nearly $2 billion a year, a new study says.

Prof. Steve Morgan of the University of British Columbia said physiological changes associated with aging alter the effects of many medications, meaning older adults shouldn’t be taking them.

The study is published in “CMAJ Open,” an open-access journal of the Canadian Medical Association, and includes prescription data from six provinces.

Morgan said the cost of non-beneficial seniors’ drugs, and hospitalization to deal with their effects, amounts to about $420 million a year in B.C., Alberta, Saskatchewan, Manitoba, Ontario, and P.E.I.

Extrapolated to the rest of the country, Morgan estimated the cost at nearly $2 billion.

In Canada, older people who have taken drugs for years for conditions such as insomnia often aren’t counselled by their doctors to try non-medicinal treatments, such as cognitive behavioural therapy and mindfulness, Morgan noted.

“Doctors aren’t necessarily paid for those longer consultations with patients; to counsel them through these decisions,” he said.

“Part of the fee-for-service system doesn’t incentivize that activity.”

Dr. Keith White, chairman of the Shared Care Polypharmacy Committee, a joint initiative of Doctors of BC and the province’s Health Ministry, said older patients sometimes suffer from complications as a result of taking too many pills.

“You go into the emergency department and you get 10 blood tests and three X-rays, which you don’t need,” said White, a family doctor in Kelwona.

“You’re only there because of the adverse effects of the drugs,” he stressed.

Health Canada noted the Canadian Institutes for Health Research established a council last year that aims to identify ways to reduce inappropriate prescribing to seniors by 50 percent by 2018.

The department said this year’s budget provided $40 million to work with provinces and territories to develop an electronic prescribing system that would identify problematic patterns.

Morgan said a national campaign to create awareness of the problem could be done similar to the “extraordinary job” the Mental Health Commission of Canada has done to open discussion about depression.

He said Australia is dealing with the issue through its Nationial Perscribing Service in a program started 16 years ago to destigmatize the conversation around medication and age.

Seniors can be on multiple pills for a range of conditions such as diabetes, heart disease, and kidney disease but their various specialists and family doctors have no way of accessing that information, White said.

“Often we don’t know why a medication is started so we’re reluctant to stop it,” he explained.

All provinces are working together to deal with the problem and recently have formed the Canadian Deprescribing Network, which aims to develop guidelines to help taper seniors off drugs, White added.

Prof. Gloria Gutman, a founding director of the Gerontology Research Centre at Simon Fraser University in the Vancouver area, said some doctors base prescribing to seniors on ageism.

“Part of it is the doctors themselves saying, ‘Oh well, these are just old people. We don’t need to work that hard to find out what else is causing the problem.’”

Gutman said she’s often surprised to learn some doctors continue prescribing drugs that have been listed for years as inappropriate for older patients.

“Is it that old doctors aren’t up to date on their reading and education, or is it that young docs aren’t getting the information in their general training?” she wondered.

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