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A pilot randomized controlled trial of deprescribing
Christopher Beer1, Poh-Kooi Loh2, Yan Gee Peng3
1WA Centre for Health and Ageing, School of Medicine and Pharmacology and Centre for Medical Research, University of Western Australia, and Department of Geriatric Medicine, Royal Perth Hospital, Level 6 Ainslie House, GPO Box X2213, Perth, WA 6847, Australia.
Deprescribing medications in older adults is feasible, with all participants successfully reducing or stopping their target medication. This study supports the need for larger trials to confirm these findings in diverse settings.
Area of Science:
- Gerontology
- Clinical Pharmacy
- Evidence-Based Medicine
Background:
- Polypharmacy and adverse drug reactions are significant concerns in the elderly population.
- Systematic medication withdrawal (deprescribing) trials are scarce.
- This study assessed the feasibility of a randomized controlled deprescribing trial.
Purpose of the Study:
- To determine the feasibility of conducting a randomized controlled trial for medication deprescribing in older adults.
- To evaluate the acceptability and safety of gradual medication withdrawal.
- To explore potential outcomes such as quality of life and cognitive function.
Main Methods:
- A small, open-label study involving community-dwelling and residential aged-care facility (RCF) residents.
- Participants were randomized into intervention (gradual medication withdrawal) or control groups.
- Primary outcome: successful medication withdrawal; secondary outcomes: quality of life, adherence, sleep, and cognition.
Main Results:
- Fifteen participants initiated medication withdrawal, with all successfully ceasing or reducing their target medication.
- Participants were elderly (mean age 80 years) and taking multiple medications (mean 9).
- Two participants withdrew from the study; one required clinical review, and another declined further dose reduction.
Conclusions:
- A randomized controlled trial investigating deprescribing is acceptable to older adult participants.
- Recruitment of participants from residential aged-care facilities is feasible.
- Further definitive trials are warranted to establish the efficacy of deprescribing interventions.
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