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

Abstract

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.

Prevalence of Polypharmacy and Potentially Inappropriate Medications Use in Elderly Chinese Patients: A Systematic Review and Meta-Analysis

“…PIM use led to high morbidity and mortality in the elderly, and the prevalence of polypharmacy increased as well ( Achterhof et al, 2020 ). Deprescribing is an established management strategy to minimize polypharmacy and PIM use ( Wu et al, 2021 ). The understanding of the clinical efficacy of reducing polypharmacy in the elderly is limited, especially in Chinese.…”

Diurnal effects of polypharmacy with high drug burden index on physical activities over 23 h differ with age and sex

“…Age-associated decline in physical performance often occurs early in the sixth decade of life and can lead to decreased independence and increased frailty 3 . Polypharmacy (concurrent use of ≥ 5 different medications) has emerged as a major healthcare challenge for older people 4 . Polypharmacy is often used to treat multimorbidity but is associated with functional/cognitive impairments 5 , and other adverse outcomes including falls, hospitalization 6 , frailty 7 , and mortality 8 .…”

Development and consensus testing of quality indicators for geriatric pharmacotherapy in primary care using a modified Delphi study

“…The global population is aging and as a consequence, more people are living with multi–morbidity and the consequent polypharmacy [ 1 – 3 ]. Polypharmacy is associated with an increased risk of adverse drug reactions (ADRs) [ 4 – 6 ].…”