Joseph G. Ouslander, M.D.

It’s time to stop prescribing medications with questionable benefits and make drug therapy safer for vulnerable older adults with life‐limiting illnesses, according to the past president of the American Geriatrics Society.

In many cases, there’s just not enough evidence to justify prescribing statins, anti-dementia drugs (cholinesterase inhibitors), anticoagulants, and intensive treatment of diabetes and hypertension in these patients, writes Joseph Ouslander, M.D., from Florida Atlantic University, in an editorial published last week.

In addition, therapy that involves these drugs and treatments may not be “consistent with a person‐centered approach to care of people with life‐limiting illnesses,” he writes, pointing to recent analyses of nursing home residents. The studies, published in the Journal of the American Geriatrics Society and detailed in his editorial, focus on specific drug classes and can be helpful to clinicians who wish to “make drug therapy safer and more rational in vulnerable older patients.”

Deprescribing isn’t easy, he acknowledged. Clinicians may need to take considerable time to explain the rationale for deprescribing to the patient and family, one recent study found.

“Success in pruning the low-hanging fruit, like in many aspects of geriatric care, will require not only interprofessional teamwork,” Ouslander wrote. “It will also require a thoughtful, person‐centered approach to the care of this patient population.”

Despite these difficulties, nursing home operators can provide leadership, oversight and support for these quality improvement initiatives, Ouslander adds. He recommends the use of electronic health records to identify prescribers and send reminders about the lack of evidence, potential harm, and excess costs of these drugs and aggressive treatments in patients with life‐limiting illness. While there may be a concern about EHR alert fatigue, “… deprescribing these drugs in patients with life‐limiting illnesses should be a priority,” he concludes.

The editorial was published in the Journal of the American Geriatrics Society.