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Proposed by the EPA sections on Psychopharmacology and Old Age Psychiatry-According to the data, more than 50% of elderly patients with mental disorders are treated with multiple drugs (e.g. 5 or more medications), which can lead to medically unnecessary polypharmacy (i.e., irrational polypharmacy). Due to frequent comorbidities and treatments in the elderly, polypharmacy is the rule rather than the exception and can lead to several harms, treatment failures, and inappropriate prescribing. Elderly patients on polypharmacy (rational and irrational) are also excluded from many clinical trials and consequently, this age group is underrepresented in meta-analyses and clinical guidelines as well, which leads to a lack of evidence-based medicine supported results useful for daily practice. In this context, the prudent deprescribing process is a key step in irrational polypharmacy reduction. The purpose of deprescribing is to reduce inappropriate polypharmacy, medication burden and harm, and to improve patient health-related outcomes. There are some tools available that can help in the deprescribing process in clinical practice, including different medication lists (e.g. Beers criteria, STOPP/START, and guidelines). This proposed joint workshop of the Section of Old Age Psychiatry and the Section of Psychopharmacology will address a neglected topic: why and when to use the deprescribing process of psychotropics in elderly patients in real clinical settings. Experts in psychiatry and psychopharmacology will specifically address the use of the deprescribing process of antidepressants, antipsychotics, hypnotics, and other psychotropics in this population. The participants will learn why is important to use deprescribing processes supported by evidence-based data and real clinical pharmacological tools useful for daily practice.
W0060 - Different General Strategies for Deprescribing in Real Clinical Settings: From Lists to Collaborative Care
ABSTRACT
Abstract Body
Most elderly patients with mental disorders are treated with polypharmacy (e.g., five or more medications), and they are receiving medications that are potentially inappropriate for elderly patients (e.g., PIMs). These aspects are often excluded in the clinical guidelines, meta-analyses, and randomized controlled trials but are very important for prudent prescribing in daily practice. The most robust approach to reducing irrational polypharmacy, PIMs, and other medications-related problems in this population is a careful deprescribing process. It is the process of tapering, withdrawing, discontinuing, or stopping medications. There are some tools available to help in the deprescribing process in clinical practice, including different medication lists (e.g., Beers criteria, STOPP/START, and guidelines) and collaborative care, including clinical pharmacist or pharmacologist. Medication lists have been used in clinical trials and guidelines, where Beers criteria are used predominantly in the U.S. and Priscus list in Europe. A collaborative care approach, including a clinical pharmacist, has been established only in some countries (e.g., USA, UK & Slovenia). The results are positive with a decrease of PIMs, polypharmacy, and an increase in the patients’ quality of life.
The participants will learn the general deprescribing processes supported by the evidence-based data and real clinical pharmacological tools useful for daily practice.
W0061 - Clinical Aspects of Deprescribing Process in Affective Disorders
ABSTRACT
Abstract Body
Although depression in the elderly is often underdiagnosed and undertreated, some data show that next to this potential underuse, antidepressant prescriptions may also be overused and prescribed inappropriately. These potentially overused and inappropriate prescriptions of antidepressants are often related to polypharmacy, comorbidity and increased mortality. Deprescribing is the planned and supervised process of reducing or stopping medications that may no longer be of benefit or may be causing harm. Clinically relevant aspects and considerations of this deprescribing process in elderly patients with affective disorders will be discussed.
Woodford HJ, Fisher J. New horizons in deprescribing for older people. Age and Ageing 2019;48:768-775.
Hiance-Delahaye A, et al. Potentially inappropriate prescription of antidepressants in old people: characteristics, associated factors, and impact on mortality. Int Psychogeriatr 2018 May;30(5):715-726.
Bobo WV, et al. Frequency and predictors of the potential overprescribing of antidepressants in elderly residents of a geographically defined U.S. population. Pharmacol Res Perspect 2019;e00461.
W0062 - Deprescribing Process in Demented Patients: What Is the Rationale?
ABSTRACT
Abstract Body
Polypharmacy is rather a rule than an exemption in the elderly. This applies also to the demented population, whether they live in private homes or in nursing homes. The application of multiple drugs increases the risk to develop delirium, to promote falling and to hasten cognitive decline, What can be done to reduce these risks? First of all, drugs should be given on the basis of an appropriate assessment. Pain e.g. may be misunderstood as challenging bevhaviour. Side affects might be misunderstood as newly occuring symptoms. Drugs should be prescribed with a written protocol, what the drug is expected to do. If this does not occur, the drug should be deprescribed. In addition, antidepressants should be deprescribed. Many demented patients receive more than two of them, mostly for years. Depresciption follows the evidence, that antidepressants are not much helpful in dementia. They may induce hyponatriamia, too. The deprescription of benzodiazepines requires patience and a long tapering-out. And overall, what about the antipsychotics? They shall be given at a minimum dosage and duration. That means, that drug pauses should be established regularly. And finally, what about the antibiotics, antihypertensive drugs and more? Having in mind, that severe dementia is mostly a state, where the priniciples of palliative medicine should be applied, also many of these drugs can be deprescribed.
W0063 - Antipsychotics for Elderly with Psychosis: Deprescribe or Continue?
ABSTRACT
Abstract Body
Maintenance treatment with antipsychotics remains the key principle in the long-term management of psychotic disorders. For some patients, it means life-long use of medication. Continuous drug administration helps to prevent relapses, maintain remission, and achieve functional recovery. Moreover, epidemiological data suggest that antipsychotic treatment significantly reduces mortality rates of schizophrenia patients. On the other hand, some authors argue that antipsychotic drugs may lose its efficacy over time, their long-term exposure results in more harm than benefit. Especially elderly patients are more sensitive to side effects. Several studies which followed-up patient cohorts over the span of several decades found that there are schizophrenia patients who can achieve good functional outcome and full recovery without antipsychotic treatment. Therefore, it is paramount to identify those individuals, particularly among elderly psychotic patients, who can thrive and benefit from timely antipsychotic discontinuation.