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Canada must create national strategy for seniors’ drugs: study

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Canada urgently needs a national strategy to ensure seniors are prescribed appropriate medications because the cost of giving them the wrong drugs has reached nearly $2-billion a year, a new study says.

Dr. Steve Morgan, a professor at the University of British Columbia, said physiological changes associated with aging alter the effects of many medications, meaning older adults shouldn't be taking them.

The study is published in CMAJ Open, an open-access journal of the Canadian Medical Association, and includes prescription data from six provinces.

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Dr. Morgan said the cost of seniors' drugs and hospitalization to deal with their effects amounts to about $420-million a year in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario and Prince Edward Island. Dr. Morgan estimates the cost for the country at nearly $2-billion.

In Canada, older people who have taken drugs for years for conditions such as insomnia often aren't counselled by their doctors to try non-medicinal treatments, such as cognitive behavioural therapy and mindfulness, Dr. Morgan said.

"Doctors aren't necessarily paid for those longer consultations with patients, to counsel them through these decisions. Part of the fee-for-service system doesn't incentivize that activity."

Dr. Keith White, chairman of the Shared Care Polypharmacy Committee, a joint initiative of Doctors of BC and the province's Health Ministry, said older patients sometimes suffer from complications as a result of taking too many pills.

"You go into the emergency department and you get 10 blood tests and three X-rays, which you don't need. You're only there because of the adverse effects of the drugs," said Dr. White, a family doctor in Kelowna.

Health Canada notes the Canadian Institutes for Health Research established a council last year that aims to identify ways to reduce inappropriate prescribing to seniors by 50 per cent by 2018. The department said this year's budget provided $40-million to work with provinces and territories to develop an electronic prescribing system that would identify problematic patterns.

Dr. Morgan said a national campaign to create awareness of the problem could be similar to the "extraordinary job" that the Mental Health Commission of Canada has done to open discussion about depression.

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He said Australia is dealing with the issue through its National Prescribing Service, a program started 16 years ago to destigmatize the conversation around medication and age.

"Health professionals are getting educated about medicines by an independent body, not as much by pharmaceutical companies, which is where the majority of our professional education comes from in Canada," Dr. Morgan said.

Seniors can be on multiple pills for a range of conditions, but their various specialists and family doctors have no way of accessing that information, Dr. White said.

"Often we don't know why a medication is started so we're reluctant to stop it," he said.

All provinces are working together to deal with the problem and have recently formed the Canadian Deprescribing Network, which aims to develop guidelines to help taper seniors off drugs, Dr. White said.

Dr. Gloria Gutman, a founding director of the Gerontology Research Centre at Simon Fraser University, said some doctors base prescribing on ageism.

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"Part of it is the doctors themselves saying, 'Oh, well. These are just old people. We don't need to work that hard to find out what else is causing the problem.' "

Dr. Gutman said she's often surprised to learn that some doctors continue prescribing drugs that have been listed for years as inappropriate for older patients.

"Is it that old doctors aren't up to date on their reading and education, or is it that young docs aren't getting the information in their general training?"

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