Deprescribing can reduce the number of inappropriate medications taken by older patients, and may increase longevity

Page AT, Clifford RM, Potter K, et al.  The feasibility and the effect of deprescribing in older adults on mortality and health: A systematic review British Journal of Clinical Pharmacology. 2016;82(3):583-623. 

Review question

In older patients taking multiple medications to manage their condition(s), how does deprescribing some of these medications affect mortality, adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage?

Background

Many older patients take multiple medications every day, which sometimes cause more harm than good. This may be associated with increased rates of impaired cognition, falls and morbidity.

These patients can work closely with their healthcare professional to reduce inappropriate medication, a process known as deprescribing.

Deprescribing has been proposed for older patients as a promising means of reducing adverse events associated with taking multiple medications, while remaining a safe intervention.

How the review was done

A detailed search of a number of electronic databases for all years up to and including February 2015 was conducted. Studies that focused on the deprescribing of one or more prescription medications in patients older than 65 were included in the review.

A total of 497 studies were identified in searches and 116 were included in the review after assessments for eligibility.

This review was funded by the University of Western Australia and the National Health and Medical Research Council.

What the researchers found

The review found that deprescribing appears to be overall feasible and generally safe. While it did not significantly affect mortality overall, a decreasing trend was noted specifically in the 65-to-80-year-old age group.

In the identified studies, deprescribing did not change the number of people who fell, but reduced the number of falls they experienced.

There were no significant increases in adverse drug-withdrawal events, and no significant changes in cognitive function and quality of life.

Conclusion

This review found that deprescribing appears to be a feasible and safe means of reducing the number of inappropriate medications taken by older patients. Deprescribing reduced mortality in the 65-to-80-year-old age group and the number of falls experienced by all patients. There is promise in applying deprescribing on an individualized basis, but more evidence is needed to further confirm the outcomes presented in this review.