Guidelines to reduce medications

nurse and patient

A new National Health and Medical Research Council (NHMRC) approved guideline developed by a CDPC funded project team will assist healthcare professionals reduce prescribing of unnecessary medications in older Australians with dementia.

This guideline gives doctors and other healthcare professionals an important tool to navigate the complex process of optimising the complexity of multiple medication use in people with dementia.

Developed by researchers based at the University of Sydney, in conjunction with the Bruyère Research Institute (Canada), the guideline contains seven recommendations that reflect the current evidence about when and how to trial withdrawal of two commonly prescribed medications.

Appropriate use of cholinesterase inhibitors and memantine, the commonly prescribed drugs for dementia treatment, needs to involve both prescribing these medications to individuals who are likely to benefit, and deprescribing (withdrawing) them for individuals where the risks outweigh the benefits.

“Clinical Guidelines can help General Practitioners and other healthcare professionals to make informed decisions,” explained guideline developer and NHMRC-ARC Dementia Research Development Fellow, Dr Emily Reeve.

“The availability of these deprescribing guidelines will provide a resource to help them, in conjunction with people with dementia and their family, decide when it is suitable for these medications to be withdrawn.

“It also gives guidance on how the medications should be withdrawn and what monitoring to do after discontinuation.”
The Australian and New Zealand Society for Geriatric Medicine has endorsed the guideline and “supports the principles of appropriate use of medications in older people and welcomes the development of these recommendations to guide clinicians and aid consumers in the goal of better, more individualised prescribing and deprescribing in older people with dementia”.

With approximately 20,000 people with dementia in Australia prescribed a cholinesterase inhibitor yearly, use of the guideline will not only reduce the burden of taking unnecessary medication and medication induced harm, but will release money that could be better spent on non-pharmacological treatment.

The guideline also emphasises the need to consider the individual as well as their values, preferences and goals of care.
The development of the guideline is part of a project funded through the NHMRC Cognitive Decline Partnership Centre (CDPC), to help determine how to manage medicines in people with dementia better in the future.

*NHMRC’s approval of the guideline recommendations indicates that they have met the NHMRC standard for clinical practice guidelines.

To access the guideline and supporting documents go to: http://sydney.edu.au/medicine/cdpc/resources/deprescribing-guidelines.php