When Less Is More: The Role of Deprescribing in the Elderly - A Narrative Review of the Evidence

Abstract

The aging population is associated with an increase in elderly individuals with multimorbidity and the consequent polypharmacy. While appropriate in some cases, this often leads to the prescription of potentially inappropriate medications. Older individuals are more susceptible to adverse events due to pharmacodynamic and pharmacokinetic changes resulting from physiological alterations typical of aging, which interfere with drug metabolism. The aging process is complex, associated with multimorbidity, geriatric syndromes, functional and/or cognitive deficits, and, consequently, limited life expectancy. Currently, about 40% of the elderly are polymedicated. Deprescribing is an activeprocess of reviewing all of a patient's medications, performed by a physician, based on a risk/benefit assessment. Polypharmacy is associated with an increased risk of mortality, falls, drug interactions, and hospitalizations. The deprescribing process can lead to a reduction of about 39% in chronic medication, resulting in increased therapeutic adherence to the remaining drugs. Deprescribing is a fundamental pillar of person- centred care, and the population should be aware of its importance. A classic review was conducted through bibliographic research of systematic reviews on Medline. This narrative review aimed to address polypharmacy and its prevalence in the elderly population, evaluate the benefits and risks of deprescribing, and identify barriers and facilitating factors in the deprescribing process.