Deprescribing in older adults with polypharmacy

Area of Science:

• Gerontology
• Pharmacology
• Health Services Research

Background:

• Polypharmacy is prevalent in older adults, leading to adverse drug events, functional decline, and increased healthcare utilization.
• Barriers to deprescribing (stopping medications) are significant, necessitating targeted interventions.
• Deprescribing interventions aim to reduce medication burden and improve outcomes in elderly populations.

Purpose of the Study:

• To review components of deprescribing interventions for older adults with polypharmacy.
• To summarize findings from randomized controlled trials (RCTs) testing these interventions.
• To report on ongoing trials, guidelines, and resources for facilitating deprescribing.

Main Methods:

• Narrative review of published RCTs and ongoing trials.
• Analysis of intervention components, including medication reviews, shared decision-making, patient priorities, professional training, patient education, and family involvement.
• Synthesis of results comparing interventions to usual care.

Main Results:

• Interventions exhibited significant heterogeneity in components and delivery settings (primarily primary care).
• Over half of the tested interventions demonstrated superiority over usual care in at least one primary outcome.
• Most studies assessed intervention effectiveness over 12 months or less.

Conclusions:

• Deprescribing interventions, particularly medication reviews with patient-centered elements, can be effective in older adults with polypharmacy.
• Further research is needed to optimize intervention design and assess long-term effectiveness.
• Heterogeneity in interventions highlights the need for tailored approaches to medication management in the elderly.