Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis

Bloomfield, Hanna E.; Greer, Nancy; Linsky, Amy; Bolduc, Jennifer; Naidl, Todd; Vardeny, Orly; MacDonald, Roderick; McKenzie, Lauren; Wilt, Timothy J

doi:10.1007/s11606-020-06089-2

Cited by 147 publications

(171 citation statements)

References 61 publications

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“…In a systematic review that aimed to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults, four trials were identified that evaluated the effect of CCDSS. 52 These trials were conducted in the USA and Canada, and only two out of the four trials reported a significant reduction of potentially inappropriate medications in the intervention group compared with the control group.…”

Section: Implementation Solutions: Computerized Clinical Decision Support Systemsmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.

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Section: Implementation Solutions: Computerized Clinical Decision Support Systemsmentioning

confidence: 99%

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Wu¹,

O’Donnell²,

Fujita³

et al. 2021

IJGM

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“…Other approaches that have been utilised in interventions to support prescribing and medication use in older people include electronic clinical decision support systems [94,95] and deprescribing [96,97]. Whilst deprescribing interventions may reduce mortality and the use of potentially inappropriate medications, and improve medication adherence [96,98,99], the effect may not be sustained, and further research is needed to determine the optimal interval of repeated deprescribing interventions [97]. A multi-faceted intervention for primary care has been proposed that includes an adapted versio n of a deprescribing protocol which may reverse prescribing cascades [100].…”

Section: Interventions To Support Medication Use In Older Adultsmentioning

confidence: 99%

An Update on Medication Use in Older Adults: a Narrative Review

Barry

Hughes

2021

Curr Epidemiol Rep

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Purpose of Review The global phenomenon of population aging is impacting the health and care needs of society. The use of medications by older adults is acknowledged to be the most common form of medical intervention for many acute and chronic conditions and prescribing in this population continues to increase. In this narrative review, we summarise the age-related factors that should be considered when prescribing for older adults, address some of the perennial challenges related to medicine use in older people, and highlight important emerging research in this area. Recent Findings A range of age-related factors should be considered when prescribing for older adults. However, the evidence base still lacks data pertaining to older adults due to their continued under-representation in clinical trials. Multimorbidity, polypharmacy, and inappropriate prescribing continue to remain prevalent among older adults, although recent research has been focused on the development and evaluation of complex interventions to address these challenges. Summary Further high-quality studies of interventions to improve and support medication use in older adults are needed, ensuring that older adults are well represented in such trials and consideration is given to the measurement of patient- and provider-focused outcomes.

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“…18,19 However, meta-analyses suggest deprescribing involving medication review (often pharmacist-led) may yield a reduction in all-cause mortality (26% relative risk reduction) among community-dwelling older adults and falls among nursing home residents. 20,21 Other patient benefits of deprescribing include improved adherence, improved quality of life, and lower financial burden 22 . Older adults with polypharmacy acknowledge their medication burden and would be willing to attempt deprescribing at least one medication if their physician said it was possible 23 .…”

Section: Introductionmentioning

confidence: 99%

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

Mohottige

Manley²,

Hall

2021

Kidney360

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Due to both age and impaired kidney function, older adults with kidney disease are at increased risk of medication-related problems and related hospitalizations. One proactive approach to minimize this risk is deprescribing. Deprescribing refers to the systematic process of reducing or stopping a medication. Aside from preventing harm, deprescribing can potentially optimize patients' quality of life by aligning medications with their goals of care. For some patients, deprescribing could involve less aggressive management of their diabetes and/or hypertension. In other instances, deprescribing targets may include potentially inappropriate medications that carry greater risk of harm than benefit in older adults, medications that have questionable efficacy, including medications that have varying efficacy by degree of kidney function, and that increase medication regimen complexity. We include a guide for clinicians to utilize in deprescribing, the List, Evaluate, Shared Decision-Making, Support (LESS) framework. The LESS framework provides key considerations at each step of the deprescribing process that can be tailored for the medications and context of individual patients. Patient characteristics or clinical events that warrant consideration of deprescribing include limited life expectancy, cognitive impairment, and health status changes, such as dialysis initiation or recent hospitalization. We acknowledge patient, clinician, and system-level challenges to the deprescribing process. These include patient hesitancy and challenges to discussing goals of care, clinician time constraints and a lack of evidence-based guidelines, as well as system-level challenges of interoperable electronic health records and limited incentives for deprescribing. However, novel evidence-based tools designed to facilitate deprescribing and future evidence on effectiveness of deprescribing could help mitigate these barriers. This review provides foundational knowledge on deprescribing as an emerging component of clinical practice and research within nephrology.

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Deprescribing for Community-Dwelling Older Adults: a Systematic Review and Meta-analysis

Cited by 147 publications

References 61 publications

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

An Update on Medication Use in Older Adults: a Narrative Review

Less is More: Deprescribing Medications in Older Adults with Kidney Disease: A Review

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