To reduce seniors’ medications, Tampa Bay providers want to ‘deprescribe’

More than a third of older adults take five or more medications daily. The practice can be harmful.
OxyContin, in 80 mg pills, in a 2013 file image.
OxyContin, in 80 mg pills, in a 2013 file image. [ LIZ O. BAYLEN | Palm Beach Post ]
Published Aug. 9, 2021

It’s not uncommon for Dr. Santosh Kamath to encounter a patient who’s taking 15 or more medications.

Kamath, a geriatrician and internist in Palmetto who works with seniors in several Tampa Bay nursing homes, said this easily becomes the norm for many older adults, particularly as multiple health conditions set in.

Known as polypharmacy, it refers to the use of five or more medications daily, a practice common for one in three older adults.

But sometimes, the medications themselves become the problem.

“There is a strong association between polypharmacy and adverse health outcomes — be it falls, hospitalizations or adverse drug events,” Kamath said. “The potential side effects can be very high, so when I get a call from a nursing home regarding a change in status of a patient, one of the first things I’m thinking is, ‘Is this due to a medication they’re on?’”

Kamath is part of a national movement of health care professionals in the aging sphere who are working to reduce the number of unnecessary — and at times harmful — medications their older patients are taking.

“I think this is going to be the future,” he said. “Because the benefits are huge — even a reduction in two medications is going to have an impact.”

Dr. Santosh Kamath, a geriatrician who works with nursing homes in Bradenton and Palmetto, aims to help his older patients reduce the number of unnecessary medications they take daily.
Dr. Santosh Kamath, a geriatrician who works with nursing homes in Bradenton and Palmetto, aims to help his older patients reduce the number of unnecessary medications they take daily. [ Hannah Critchfield ]

Polypharmacy is particularly pronounced with people living in long-term care homes, as they are more likely to have multiple medical conditions.

But it happens to seniors everywhere, according to Dr. Sabine von Preyss-Friedman, a geriatrician and chief medical officer at Avalon Health Care Group, which runs senior care facilities across the county.

“With our fractured system, there’s a lot of specialists involved in the patient’s care,” she said. “And each of them wants to do the best for their patient — if the patient’s having a lot of symptoms, medications get added on and on and on.”

Interactions between these medications can have unintended negative side effects, as can “leftover” drugs first prescribed decades ago.

“Sometimes it’s really not clear why a patient is on a medication, or who prescribed it, and once you don’t know any of that, it’s really hard to make decisions,” von Preyss-Friedman said. “But if the risks now outweigh the benefits, the medication needs to be adjusted.”

Pills that may have been beneficial for a person to take 10 years ago may not be relevant now.

If a person has advanced dementia, for example, they may no longer need a high dose of anti-anxiety medication, which can have side effects like dizziness and fatigue — placing them at increased risk of falls, the most common danger of inappropriate polypharmacy.

Such polypharmacy often creates a feedback loop known as a “prescribing cascade” — a senior gets side effects from a medication, and then those side effects are treated with another medication.

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In March, the Society for Post-Acute and Long-Term Care Medicine launched a campaign to help long-term care facilities tackle medication overloads among their residents. Known as the “Drive to Deprescribe” initiative, about 4,500 long-term care facilities across the nation have signed on, with a goal of reducing medications taken by full-time residents by 25 percent.

“Some of these medications really need to be there — so it’s more like medication management,” said von Preyss-Friedman, who co-chairs the Drive to Deprescribe work group. “And giving the medical directors, the practitioners and the attending physicians the tools for how to do that.”

Through monthly calls, the initiative trains long-term care staff to engage in conversations with residents and their families and work alongside them to align a resident’s medications with their goals.

“If someone says, ‘I’m tired all the time so I can’t visit my grandchildren,’” Sabine said, “saying, ‘You know, that sleeping pill may be really contributing to that — and you told me you are still waking up three or four times a night. So this pill is probably one that doesn’t help you.’

“It’s really about looking at the entirety of the patient, and pointing out which medications may interfere with their goals,” she added.

The exact number of facilities participating in the Tampa Bay area is unknown — a society spokesperson declined to provide the names or numbers without prior approval from area long-term care homes, and said they all turned down requests for interview.

Kamath, who works at Surrey Place Healthcare and Rehabilitation in Bradenton and Riviera Palms Rehabilitation Center in Palmetto, said he does not believe either of his facilities have formally signed on. He nevertheless attends Drive to Deprescribe trainings and works with facility nursing directors and pharmacists to integrate this practice into their patients’ care. Neither facility responded to requests for comment.

“It has a significant impact in improving patient outcomes — just by getting rid of the unnecessary things,” he said.

Kamath said that should he become the medical director at a facility in the future, one of the first things he’d do is sign his long-term care home on to participate in the campaign.