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Editor's Correspondence |

Reducing Drugs in Older Adults Is More

Danijela Gnjidic, PhD, MPH; David G. Le Couteur, MD, PhD; Darrell R. Abernethy, MD, PhD; Sarah N. Hilmer, MD, PhD
Arch Intern Med. 2011;171(9):868-869. doi:10.1001/archinternmed.2011.207.
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With great interest we read the article published by Garfinkel and Mangin1 on the systematic approach for discontinuation of medicines in older adults. The authors safely discontinued 311 medications across drug classes in 64 participants using the Good Palliative–Geriatric Practice (GP-GP) algorithm. The results will provide a very important evidence base for the practice of geriatric pharmacology.

The application of the GP-GP framework and the assessment of the risks and benefits of the patients' drug therapy were based on the physicians' individual reviews. Estimating the risks of prescribing using this approach may limit the recognition of adverse events in older adults and relies heavily on the experience and knowledge of each physician. To make this algorithm more applicable and generalizable between practitioners, the risk assessment tools based on the drug classes known to increase the risk of adverse events in older adults could be incorporated into the GP-GP algorithm. For example, physicians could use risk assessment tools such as the Drug Burden Index (DBI),2 the Anticholinergic Risk Scale (ARS),3 or the sedative load4 to guide their medication review process. Such tools provide measures of exposure to medicines with anticholinergic and/or sedative effects. The DBI has been associated with impairments in physical and cognitive functions in older adults.2 The feasibility of using the DBI tool alone, without the initial clinical judgment steps of the GP-GP algorithm, to reduce the exposure to anticholinergic and sedative medications in older people was recently tested in a pilot randomized clinical trial.5 The feasibility of using the ARS3 and sedative load4 tools to reduce medication exposure is yet to be investigated in randomized clinical trials.

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