Polypharmacy needs prevention and education
Stopping “as many non-life-saving” drugs as possible” misses the crucial point that quality of life can be at least as important as length for this group of patients just as using death or hospital admission as the primary endpoints in the study may be inappropriate. The study recruited patients over 75 but not everyone over 75 is in the VOCODFLEX group as defined in the commentary. Perhaps we need to re-think some of our attitudes towards polypharmacy.
It is all too easy to refuse to prescribe adequate analgaesia, NSAIDs, and a range of psychotropic compounds such as antidepressants. Because a drug leads to a hospital admission does not necessarily indicate poor prescribing. Despite admission and a potentially life-threatening complications some elderly patients are keen to continue on treatments for quality of life benefits. Limiting risk may make an additional drug necessary such as adding proton pump inhibitors if the patient insists on taking NSAIDs. We may need to accept that medical treatment can lead to hospital admissions just as we would not see some complications from surgery as a clear contraindication to a procedure. Many older people also buy large numbers of products from health stores and supermarkets and perhaps the inconvenience of taking multiple drugs can be overrated. As someone who is over 80 and so far has restricted myself to treatments with a clear symptomatic benefit and eschewing those aimed at “life-saving”, I had a minor, uncomplicated operation recently. I was interested to see from my anaesthetic chart that I received nine different preparations with an entire side of the drug chart filled with post op options (none used).
We should be learning to live with polypharmacy but think harder when starting new compounds in the first place, defining the aims of treatment in close discussion with the patient and with an exit strategy. This may mean discussing individual quality of life issues and that life is drawing towards a close as well as discussion with the family - and any carers - who may have their own agenda. These discussions will have significant resource implications which will need to taken into account when recommending policies.
Competing interests: No competing interests