I read the informative article about deprescribing in older people by Michelle Liacos, Amy Page and Christopher Etherton-Beer.1 While appreciating their efforts, I wish to make the following observations.
Table 3 of the article lists tools to support deprescribing decisions. Explicit tools like the Beers2 and STOPP criteria3 can also be applied to detect inappropriate medications in the elderly and would be a useful addition to the article.
Regarding the section on adverse effects, there are some serious concerns about proton pump inhibitors which are worth mentioning. Elderly patients are especially prone to developing osteoporosis-related fractures.3 Long-term use of proton pump inhibitors (for more than one year) independently increases this risk. Long-term use also increases the risk of vitamin B12 deficiency, hypomagnesemia and fundic gland polyps.4
REFERENCES
- 1.Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr 2020;43:114-20. 10.18773/austprescr.2020.033 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Duke Clinical Research Institute. Beers criteria medication list. https://dcri.org/beers-criteria-medication-list [cited 2020 Nov 1]
- 3.O’Mahony D, O’Sullivan D, Byrne S, O’Connor MN, Ryan C, Gallagher P. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 2015;44:213-8. 10.1093/ageing/afu145 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Kinoshita Y, Ishimura N, Ishihara S. Advantages and disadvantages of long-term proton pump inhibitor use. J Neurogastroenterol Motil 2018;24:182-96. 10.5056/jnm18001 [DOI] [PMC free article] [PubMed] [Google Scholar]