Death rate in nursing home cut in half by just discontinuing unneeded medications – trial June 2007

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The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people

Isr Med Assoc J. 2007 Jun;9(6):430-4.
Doron Garfinkel 1, Sarah Zur-Gil, Joshua Ben-Israel

Background: The extent of medical and financial problems of polypharmacy in the elderly is disturbing, particularly in nursing homes and nursing departments.

Objectives: To improve drug therapy and minimize drug intake in nursing departments.

Methods: We introduced a geriatric-palliative approach and methodology to combat the problem of polypharmacy. The study group comprised 119 disabled patients in six geriatric nursing departments; the control group included 71 patients of comparable age, gender and co-morbidities in the same wards. After 12 months, we assessed whether any change in medications affected the death rate, referrals to acute care facility, and costs.

Results: A total of 332 different drugs were discontinued in 119 patients (average of 2.8 drugs per patient) and was not associated with significant adverse effects. The overall rate of drug discontinuation failure was 18% of all patients and 10% of all drugs.

• The 1 year mortality rate was 45% in the control group
• but only 21% in the study group (P < 0.001, chi-square test).

The patients' annual referral rate to acute care facilities was

• 30% in the control group but only
• 11.8% in the study group (P < 0.002).

The intervention was (also) associated with a substantial decrease in the cost of drugs.

Conclusions: Application of the geriatric-palliative methodology in the disabled elderly enables simultaneous discontinuation of several medications and yields a number of benefits: reduction in mortality rates and referrals to acute care facilities, lower costs, and improved quality of living.

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This study was cited 375 times as of Sept 2023

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• A systematic review of the evidence for deprescribing interventions among older people living with frailty - April 2021 https://doi.org/10.1186/s12877-021-02208-8 FREE PDF
  • "... studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits"
• Deprescribing for older people living in residential aged care facilities: Pharmacist recommendations, doctor acceptance and implementation - April 2023 https://doi.org/10.1016/j.archger.2022.104910
• Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: A systematic review Sept 2019 https://doi.org/10.1111/bcp.14113 FREE PDF
• Impact of a pharmacist-administered deprescribing intervention on nursing home residents: a randomized controlled trial - June 2020 https://doi.org/10.1007/s11096-020-01073-6 FREE PDF

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See also: Off topic – Half of seniors now take 5 or more drugs daily (before only 12 percent took 5) – July 2018

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See also: 13 reasons why many seniors need more vitamin D (both dose and level) - July 2023 contains

1. Senior skin produces 4X less Vitamin D for the same sun intensity
2. Seniors have fewer vitamin D receptor genes as they age
   Receptors are needed to get Vitamin D in blood actually into the cells
3. Many other Vitamin D genes decrease with age
4. Since many gene activations are not detected by a blood test,
   more Vitamin D is often needed, especially by seniors
5. Seniors are indoors more than when they were younger
   not as agile, weaker muscles; frail, no longer enjoy hot temperatures
6. Seniors wear more clothing outdoors than when younger
   Seniors also are told to fear skin cancer & wrinkles
7. Seniors often take various drugs which end up reducing vitamin D
   Some reductions are not detected by a vitamin D test of the blood
   statins, chemotherapy, anti-depressants, blood pressure, beta-blockers, etc
8. Seniors often have one or more diseases that consume vitamin D
   osteoporosis, diabetes, Multiple Sclerosis, Cancer, ...
9. Seniors generally put on weight as they age - and a heavier body requires more vitamin D
10. Seniors often (40%) have fatty livers – which do not process vitamin D as well
11. Reduced stomach acid means less Magnesium is available to get vitamin D into the cells
12. Vitamin D is not as bioavailable in senior intestines
13. Seniors with poorly functioning kidneys do not process vitamin D as well
       Seniors category has 428 items