Promoting a Culture of Deprescribing to Enhance Resident Well-being

Long-term care and senior living residents often take many medications each day – sometimes, this polypharmacy is not necessary and can even cause harm. Decisions about the most appropriate medication regimen is best made when everyone – including the resident, family, community staff, pharmacist, and healthcare providers – works together. Everyone on the resident’s care team has a role to play in making medication management safer and more effective, and fostering a culture of deprescribing with the community can have lasting benefits to resident well-being.

After a pause during the pandemic, the approach to medication management in long-term care is once again undergoing a significant shift towards deprescribing, the process of thoughtfully reducing and discontinuing medications that may no longer be beneficial or have the potential to cause harm. It is a nuanced practice aimed at ensuring each resident’s medication regimen is optimized for their current health status, mitigating the potential for adverse drug reactions, polypharmacy, and inappropriate use. Deprescribing is foundational to good prescribing – backing down when doses are too high, or discontinuing medications that may no longer be necessary.

As a regional director of clinical and consultant services, I have witnessed firsthand the profound impact deprescribing can have on the quality of life for residents while also reducing the burden on community staff.

How Deprescribing Boosts Resident Outcomes

Reducing the number of medications a resident takes, where possible, often boosts their overall well-being, underscoring the importance of quality over quantity in medication management. For instance, minimizing high fall risk medications can significantly reduce the likelihood of falls, promoting resident safety and autonomy. Similarly, decreasing the anticholinergic burden or unnecessary psychotropic medications can mitigate the risk of prescribing cascades—when a drug is used to treat the side effects of another drug—and adverse drug reactions, enhancing overall health outcomes. Eliminating any duplicate or unnecessary therapies improves medication adherence—a proven strategy to improve outcomes and reduce hospitalizations—while minimizing the risk for medication errors and reducing out-of-pocket costs for residents.

Added Benefits to the Community

The benefits of deprescribing extend beyond resident care quality. It also brings value to the community and its care staff by streamlining operations and simplifying the med pass, decreasing the chances of medication errors, and minimizing transcription errors during transitions of care.

While the advantages are numerous, overzealous deprescribing can result in adverse drug withdrawal reactions. It requires a careful, individualized assessment of each resident’s medication needs and close monitoring throughout the deprescribing process to ensure medical conditions remain well managed.

The deprescribing initiative is not a new concept. The pandemic briefly stalled the momentum toward deprescribing, as communities faced the daunting task of adjusting to COVID-19 restrictions while addressing the mental health challenges of residents, including isolation, depression, and anxiety. This period made reducing medications particularly difficult. However, post-pandemic, the engagement of family members and caregivers in residents’ healthcare has been instrumental in helping communities revive deprescribing.

Creating a Culture of Deprescribing

To foster a culture of deprescribing in long-term care and senior living settings, providers should adopt four key behaviors.¹