The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

Abstract

AIMSDeprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. METHODSSpecified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). RESULTSA total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patientspecific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69). CONCLUSIONSAlthough nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies. WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Polypharmacy in older adults is correlated to poor health outcomes.• Deprescribing is one proposed intervention to reduce the harm associated with polypharmacy.• Limited evidence is available to support deprescribing as an intervention. British Journal of Clinical PharmacologyBr J Clin Pharmacol (2016) 82 583-623 583

Deprescribing: a new goal focused on the patient

“…Another recently published trial found that deprescription protocols can be applied in frail elderly patients without adversely affecting their survival [1]. Patient-specific interventions are gaining evidence in mortality reduction effect [9] but more studies are needed to detect the influence of deprescription on multiple outcomes.…”

A concept analysis of deprescribing medications in older people

“…17 31 It was highlighted again in three more recent systematic reviews. 2,32,33 Deprescribing was defined as 'medication withdrawal in older people' in a 2008 systematic review of withdrawing individual medications. 31 Le Couteur et al clarified that this was the 'cessation of long-term therapy supervised by a clinician'.…”

“…It is challenging to reduce the total number of medications taken, but recent research has indicated it is feasible. 32,35 Adverse effects can prompt deprescribing. 35 Many people experience side effects of their medications that can range from mildly irritating to intolerable or life-threatening.…”

“…69 ADWEs are detected as clinically significant signs or symptoms that occur because of medication withdrawal. 32 ADWEs are an emergence or reemergence of clinical signs or symptoms. 69 They may range from mild to serious and temporary to permanent reactions.…”

“…a common word. 2,32,33,54 As described earlier, the use of the word 'deprescribing' is a suggested approach to link relevant research. 30,31 This challenge to search and retrieve relevant research is a barrier to research distribution.…”