Geriatric physician focuses on ‘deprescribing’ — removing medications from patients’ regimen that are no longer effective
By Chris Motola
Q: What is “deprescribing,” and how does it apply to geriatrics?
A: The way I think of deprescribing is as the opposite of prescribing. So, really, it’s the process of stopping medicine that may no longer be helping the patient, or may be causing the patient more harm than good. I think it’s especially prevalent in geriatrics, because a lot of our older adults are on many medications that they may no longer need. It might have been started at an earlier age, and it might not be benefiting them the way it was previously. I think it’s really important to review these medications with your older adult patients and make sure they aren’t causing unnecessary harm.
Q: What kinds of medications tend to fall into this category?
A: I think some of the biggest categories that we look for are medications that are associated with falls. Things like blood pressure medication, medications that can be involved in memory loss or cognitive decline and medications that lower blood sugar, since having low blood sugar can cause a lot of problems in older patients. Some of the other ones I’ve had to look at are vitamin supplements, aspirin, cholesterol medications. Those are some of the bigger categories that I look at.
Q: Since I’m assuming the underlying conditions the medications were treating still exist, do you look at alternative medications, or is it more just a cost-benefit analysis for quality of life?
A: I think it’s a lot of different things. I think each patient is a little bit different. It gets really challenging when you have older adults who have many chronic medical problems, because there’s a lot of evidence that these medications should be used to treat these patients. The problem is a lot of these studies are looking at younger patients. There’s not a lot of data for people as they get over the age of 70, showing whether those medications are still beneficial. I really try to target medications that may be doing more harm than good, things like vitamin supplements where there’s evidence that they might not being doing as much good.
Q: What kind of toll does taking medication take on the body over the longterm?
A: That’s a great point to bring up. As we get older, a lot of the processes in our body tend to change; things like your liver, your kidney, the systems the body uses to clear those medications tend to slow down. The other thing to think about is that being on a lot of medications increases the chances of drug interactions and side effects. Any medication we put into the body has the potential to cause side effects. This can lead to more emergency room visits, falls, memory loss and hospital visits. So, we need to be thinking both about how the body clears medications and side effects.
Q: What concerns do patients have about deprescribing, and how do you work around them?
A: I think a lot of times, people get used to taking medications and are worried about what stopping it would mean. A lot of it is just having a conversation with your patient, going through the data and what the recommendations are, and going over the side effects. A lot of times people know what a medication can do for them but don’t really know much about how the side effects may be affecting them. I think that provides them with a little more comfort. They tend to be OK with stopping medication. In studies, when asked if they’d prefer to be on fewer medications, the majority of participants would prefer to be on fewer. So, it’s often just about reassuring them that it’s OK to stop taking them.
Q: What brought you back to Rochester?
A: I trained at the University of Colorado for internal medicine and then came back here for my fellowship, but after living around the country, I really like the Rochester community and wanted to be able to serve it. I feel really lucky that I’m able to.
Q: Do attitudes toward medications differ across the country?
A: I wouldn’t say they differ by region, more by specialty. I think geriatrics brings a bit more understanding to the table with regard to medications in older adults and medication interactions.
Q: Did your training as D.O. inform some of your philosophy towards medications?
A: To a certain degree. I think we’re trained from the perspective of looking at the whole person. We have very similar outlooks and training as M.D.s, but we have a little bit more of a holistic philosophy. Looking at quality of life, what’s important to the patient. That’s not to say M.D.s don’t do that, but we really stress looking at the whole being.
Q: I’m told you’re an accomplished musician.
A: Yes, I play the cello. I had joined the Brighton Orchestra for a little while, but with time constraints and trying to build my practice, I haven’t pursued that further. But I can see myself getting involved with local orchestras. I really enjoy playing. It’s something I’m very passionate about.
Lifelines
Name: Rebecca Kant, D.O. (Doctor of Osteopathic Medicine)
Hometown: Pittsford
Position: Geriatric physician at St. Ann’s Community and Pillar Medical Associates in Rochester.
Education: University of Notre Dame (undergraduate degree); Philadelphia College of Osteopathic Medicine
Training: Internal medicine residency program at the University of Colorado. Completed her training with a fellowship in geriatrics at the University of Rochester.
Organizations: Affiliation: Board-certified in internal medicine and geriatrics and a member of the American Geriatrics Society (AGS) and Society for Post-Acute and Long-Term Care Medicine (AMDA).
Family: Two dachshunds
Hobbies: Learning to cook, playing the cello, running