Rochon, PA et al. Polypharmacy, Inappropriate Prescribing, and Deprescribing in Older People: Through a Sex and Gender Lens. Lancet Healthy Longev. 2021 May; 2(5) e290-300. DOI: https://doi.org/10.1016/S2666-7568(21)00054-4
Appropriate prescribing and medication optimization is important as older adults age, but little attention has been paid to the sex and gender differences of prescribing in older age. In this review article, primary author Dr. Paula Rochon and team assess optimal prescribing practices via tools and frameworks for inappropriate prescribing in older adults with an emphasis on these differences. The authors found that although there are a number of frameworks, tools, and processes related to appropriate prescribing, none of them were developed with sex and gender differences in mind. Several of them, however, have been used by researchers to evaluate these differences. For example, the Beers Criteria have been studied by investigators internationally who often find that women are more likely to be prescribed a potentially inappropriate medication (PIM). Similarly, the STOPP Criteria have been used by researchers in Spain to demonstrate that older women (78%) are prescribed PIMs more often than older men (66%). Because of the dearth of tools and frameworks developed with sex and gender considerations, the authors developed a guide called DRUGS, used to optimize medications for older adults, with special note about how to apply elements of the framework through a sex and gender lens.
This guide has 5 components:
- 1) Discuss goals of care;
- 2) Review medications;
- 3) Use tools and frameworks;
- 4) Geriatric medicine approach;
- 5) Stop inappropriate medications.
An example of how a sex and gender lens can be applied to this framework is that for step (3), women are more likely to receive psychoactive drugs then men and might require lower doses of medications.
This guide has practical applications to help clinicians assess inappropriate medications and deprescribe when necessary.
Primary author Dr. Paula Rochon says:
“Our review encourages clinicians to consider how sex (biologic) and gender (sociocultural) factors should inform medication prescribing and deprescribing decisions for older adults. We hope that the “DRUGS” approach to optimizing medication safety for older adults will encourage clinicians to routinely incorporate sex and gender considerations into their decision-making. Only then can we truly optimize prescribing for older women and men.”