Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions

References

• Charlesworth CJ, Smit E, Lee DS, Alramadhan F, Odden MC. Polypharmacy among adults aged 65 years and older in the United States: 1988-2010. J Gerontol A Biol Sci Med Sci. 2015;70:989–995. doi:10.1093/gerona/glv013
   PubMed Web of Science ®Google Scholar
• Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther. 2009;85:86–88. doi:10.1038/clpt.2008.224
   PubMed Web of Science ®Google Scholar
• Hilmer SN, Wu H, Zhang M. Biology of frailty: implications for clinical pharmacology and drug therapy in frail older people. Mech Ageing Dev. 2019;181:22–28. doi:10.1016/j.mad.2019.111119
   PubMed Web of Science ®Google Scholar
• Gnjidic D, Hilmer SN, Blyth FM, et al. High-risk prescribing and incidence of frailty among older community-dwelling men. Clin Pharmacol Ther. 2012;91:521–528. doi:10.1038/clpt.2011.258
   PubMed Web of Science ®Google Scholar
• Gnjidic D, Hilmer SN, Blyth FM, et al. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65:989–995. doi:10.1016/j.jclinepi.2012.02.018
   PubMed Web of Science ®Google Scholar
• Wu H, Mach J, Le Couteur DG, Hilmer SN. Fall-related mortality trends in Australia and the United Kingdom: implications for research and practice. Maturitas. 2020;142:68–72. doi:10.1016/j.maturitas.2020.07.008
   PubMed Web of Science ®Google Scholar
• Wu H, Mach J, Le Couteur DG, Hilmer SN. Nationwide mortality trends of delirium in Australia and the United States from 2006 to 2016. Australas J Ageing. 2021. doi:10.1111/ajag.12926
   Web of Science ®Google Scholar
• Wu H, Le Couteur DG, Hilmer SN. Mortality trends of stroke and dementia: changing landscapes and new challenges. J Am Geriatr Soc. 2021. doi:10.1111/jgs.17322
   Web of Science ®Google Scholar
• Waller S. Reducing medication-related harm through quality use of medicines. J Pharm Pract Res. 2020;50:374–376. doi:10.1002/jppr.1692
   Google Scholar
• Donaldson LJ, Kelley ET, Dhingra-Kumar N, Kieny MP, Sheikh A. Medication without harm. WHO’s third global patient safety challenge. Lancet. 2017;389:1680–1681. doi:10.1016/s0140-6736(17)31047-4
   PubMed Web of Science ®Google Scholar
• Woodward MC. Deprescribing: achieving better health outcomes for older people through reducing medications. J Pharm Pract Res. 2003;33:323–328. doi:10.1002/jppr2003334323
   Google Scholar
• Reeve E, Gnjidic D, Long J, Hilmer S, Systematic A. Review of the EMERGING DEfiNITION of ‘Deprescribing’ with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol. 2015;80:1254–1268. doi:10.1111/bcp.12732
   PubMed Web of Science ®Google Scholar
• Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827–834. doi:10.1001/jamainternmed.2015.0324
   PubMed Web of Science ®Google Scholar
• Brodaty H, Aerts L, Harrison F, et al. Antipsychotic deprescription for older adults in long-term care: the halt study. J Am Med Dir Assoc. 2018;19(592–600.e7). doi:10.1016/j.jamda.2018.05.002
   Web of Science ®Google Scholar
• Wu H, Mach J, Gemikonakli G, et al. Polypharmacy results in functional impairment in mice: novel insights into age and sex interactions. J Gerontol a Biol Sci Med Sci. 2021. doi:10.1093/gerona/glab088
   Web of Science ®Google Scholar
• Huizer-Pajkos A, Kane AE, Howlett SE, et al. Adverse geriatric outcomes secondary to polypharmacy in a mouse model: the influence of aging. J Gerontol a Biol Sci Med Sci. 2016;71:571–577. doi:10.1093/gerona/glv046
   PubMed Web of Science ®Google Scholar
• Mach J, Gemikonakli G, Logan C, et al. Chronic Polypharmacy with Increasing Drug Burden Index (Dbi) exacerbates frailty and impairs physical function, with effects attenuated by deprescribing, in aged mice. J Gerontol a Biol Sci Med Sci. 2020. doi:10.1093/gerona/glaa060
   Web of Science ®Google Scholar
• Eroli F, Johnell K, Latorre Leal M, et al. Chronic polypharmacy impairs explorative behavior and reduces synaptic functions in young adult mice. Aging (Albany N Y). 2020;12:10147–10161. doi:10.18632/aging.103315
   PubMedGoogle Scholar
• Hilmer SN. Calculating and using the drug burden index score in research and practice. Expert Rev Clin Pharmacol. 2018;11:1053–1055. doi:10.1080/17512433.2018.1528145
   PubMed Web of Science ®Google Scholar
• Liacos M, Page AT, Etherton-Beer C. Deprescribing in Older People. Aust Prescr. 2020;43:114–120. doi:10.18773/austprescr.2020.033
   PubMed Web of Science ®Google Scholar
• Reeve E, Moriarty F, Nahas R, et al. Review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms. Expert Opin Drug Saf. 2018;17:39–49. doi:10.1080/14740338.2018.1397625
   PubMed Web of Science ®Google Scholar
• Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD, Feasibility T. Effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82:583–623. doi:10.1111/bcp.12975
   PubMed Web of Science ®Google Scholar
• Thompson W, Farrell B. Deprescribing: what is it and what does the evidence tell us? Can J Hosp Pharm. 2013;66:201–202. doi:10.4212/cjhp.v66i3.1261
   PubMedGoogle Scholar
• Earl TR, Katapodis ND, Schneiderman SR, Shoemaker-Hunt SJ. Using deprescribing practices and the screening tool of older persons’ potentially inappropriate prescriptions criteria to reduce harm and preventable adverse drug events in older adults. J Patient Saf. 2020;16:S23–s35. doi:10.1097/pts.0000000000000747
   PubMed Web of Science ®Google Scholar
• Thompson W, Reeve E, Moriarty F, et al. Deprescribing: future directions for research. Res Soc Admin Pharm. 2019;15:801–805. doi:10.1016/j.sapharm.2018.08.013
   PubMed Web of Science ®Google Scholar
• Burghle A, Lundby C, Ryg J, et al. Attitudes Towards Deprescribing among Older Adults with Limited Life Expectancy and Their Relatives: a Systematic Review. Drugs Aging. 2020;37:503–520. doi:10.1007/s40266-020-00774-x
   PubMed Web of Science ®Google Scholar
• Caughey GE, Tait K, Vitry AI, Shakib S. Influence of medication risks and benefits on treatment preferences in older patients with multimorbidity. Patient Prefer Adherence. 2017;11:131–140. doi:10.2147/ppa.S118836
   PubMed Web of Science ®Google Scholar
• Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD, Benefits T. Harms of Deprescribing. Med J Aust. 2014;201:386–389. doi:10.5694/mja13.00200
   PubMed Web of Science ®Google Scholar
• Doherty AJ, Boland P, Reed J, et al. Barriers and facilitators to deprescribing in primary care: a systematic review. BJGP Open. 2020;4:bjgpopen20X101096. doi:10.3399/bjgpopen20X101096
   PubMedGoogle Scholar
• Reeve E, Jordan V, Thompson W, et al. Withdrawal of Antihypertensive Drugs in Older People. Cochrane Database Syst Rev. 2020. doi:10.1002/14651858.CD012572.pub2
   PubMed Web of Science ®Google Scholar
• Scott IA, Pillans PI, Barras M, Morris C. Using Emr-enabled computerized decision support systems to reduce prescribing of potentially inappropriate medications: a narrative review. Ther Advan Drug Saf. 2018;9:559–573. doi:10.1177/2042098618784809
   PubMed Web of Science ®Google Scholar
• Reeve E. Deprescribing tools: a review of the types of tools available to aid deprescribing in clinical practice. J Pharm Pract Res. 2020;50:98–107. doi:10.1002/jppr.1626
   Google Scholar
• Australian Deprescribing Network (ADeN). Available from: https://australiandeprescribingnetwork.com.au/. Accessed May 5, 2021.
   Google Scholar
• Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30:793–807. doi:10.1007/s40266-013-0106-8
   PubMed Web of Science ®Google Scholar
• Reeve E, Low LF, Hilmer SN. Beliefs and Attitudes Of Older Adults And Carers About Deprescribing Of Medications: A Qualitative Focus Group Study. Br J Gen Pract. 2016;66:e552–60. doi:10.3399/bjgp16X685669
   PubMed Web of Science ®Google Scholar
• Quality Use of Medicines to Optimise Ageing in Older Australians. Recommendations for a National Strategic Action Plan to Reduce Inappropriate Polypharmacy. NHMRC Cognitive Decline Partnership Centre, University of Sydney, in Collaboration with the Australian Deprescribing Network and NPS MedicineWise. Sydney, NSW, Australia. Available from: https://cdpc.sydney.edu.au/wp-content/uploads/2019/06/quality-use-of-medicines.pdf. Accessed March 1, 2021.
   Google Scholar
• Steinman MA, Landefeld CS. Overcoming inertia to improve medication use and deprescribing. JAMA. 2018;320:1867–1869. doi:10.1001/jama.2018.16473
   PubMed Web of Science ®Google Scholar
• Medication without Harm. Global Patient Safety Challenge on Medication Safety. Geneva: World Health Organization; 2017. Available from:: https://www.who.int/patientsafety/medication-safety/medication-without-harm-brochure/en/. Accessed March 1, 2021.
   Google Scholar
• Ailabouni NJ, Nishtala PS, Mangin D, Tordoff JM. Challenges and enablers of deprescribing: a general practitioner perspective. PLoS One. 2016;11:e0151066. doi:10.1371/journal.pone.0151066
   PubMed Web of Science ®Google Scholar
• Smith H, Miller K, Barnett N, et al. Person-centred care including deprescribing for older people. Pharmacy (Basel, Switzerland). 2019. doi:10.3390/pharmacy7030101
   Google Scholar
• Jansen J, Naganathan V, Carter SM, et al. Too much medicine in older people? deprescribing through shared decision making. BMJ. 2016;353:i2893. doi:10.1136/bmj.i2893
   PubMed Web of Science ®Google Scholar
• Institute for Healthcare Improvement. What is an Age-Friendly Health System? Available from: http://www.ihi.org/Engage/Initiatives/Age-Friendly-Health-Systems/Pages/default.aspx. Accessed June 06, 2021.
   Google Scholar
• Ulley J, Harrop D, Ali A, Alton S, Fowler Davis S. Deprescribing interventions and their impact on medication adherence in community-dwelling older adults with polypharmacy: a systematic review. BMC Geriatr. 2019;19:15. doi:10.1186/s12877-019-1031-4
   PubMed Web of Science ®Google Scholar
• McKean M, Pillans P, Scott IA. A medication review and deprescribing method for hospitalised older patients receiving multiple medications. Intern Med J. 2016;46:35–42. doi:10.1111/imj.12906
   PubMed Web of Science ®Google Scholar
• O’Mahony D. Stopp/Start Criteria for potentially inappropriate medications/potential prescribing omissions in older people: origin and progress. Expert Rev Clin Pharmacol. 2020;13:15–22. doi:10.1080/17512433.2020.1697676
   PubMed Web of Science ®Google Scholar
• Ng B, Duong M, Lo S, Le Couteur D, Hilmer S. Deprescribing perceptions and practice: reported by multidisciplinary hospital clinicians after, and by medical students before and after, viewing an E-Learning Module. Res Social Adm Pharm. 2021. doi:10.1016/j.sapharm.2021.03.002
   Web of Science ®Google Scholar
• Kashyap M, Thuermann P, Le Couteur DG, Abernethy DR, Hilmer SN. Iuphar international geriatric clinical pharmacology curriculum for medical students. Pharmacol Res. 2019;141:611–615. doi:10.1016/j.phrs.2019.01.032
   PubMed Web of Science ®Google Scholar
• Gillaizeau F, Chan E, Trinquart L, et al. Computerized advice on drug dosage to improve prescribing practice. Cochrane Database Syst Rev. 2013;11:CD002894. doi:10.1002/14651858.CD002894.pub3
   Web of Science ®Google Scholar
• Rankin A, Cadogan CA, Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018;9:CD008165. doi:10.1002/14651858.CD008165.pub4
   PubMed Web of Science ®Google Scholar
• Roshanov PS, Fernandes N, Wilczynski JM, et al. Features of effective computerised clinical decision support systems: meta-regression of 162 randomised trials. BMJ. 2013;346:f657. doi:10.1136/bmj.f657
   PubMed Web of Science ®Google Scholar
• Monteiro L, Maricoto T, Solha I, Ribeiro-Vaz I, Martins C, Monteiro-Soares M. Reducing potentially inappropriate prescriptions for older patients using computerized decision support tools: systematic review. J Med Internet Res. 2019;21:e15385. doi:10.2196/15385
   PubMed Web of Science ®Google Scholar
• Bloomfield HE, Greer N, Linsky AM, et al. Deprescribing for community-dwelling older adults: a systematic review and meta-analysis. J Gen Intern Med. 2020;35:3323–3332. doi:10.1007/s11606-020-06089-2
   PubMed Web of Science ®Google Scholar
• Dalton K, O’Brien G, O’Mahony D, Byrne S. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis. Age Ageing. 2018;47:670–678. doi:10.1093/ageing/afy086
   PubMed Web of Science ®Google Scholar
• Iankowitz N, Dowden M, Palomino S, Uzokwe H, Worral P. The effectiveness of computer system tools on potentially inappropriate medications ordered at discharge for adults older than 65 years of age: a systematic review. JBI Libr Syst Rev. 2012;10:798–831. doi:10.11124/jbisrir-2012-68
   PubMedGoogle Scholar
• Fujita K, Kushida K, Okada H, Moles RJ, Chen TF. Developing and testing a set of quality indicators for pharmacist home visit services: a mixed methods study in Japan. Br J Clin Pharmacol. 2021;87:1940–1952. doi:10.1111/bcp.14587
   PubMed Web of Science ®Google Scholar
• Lawrence M, Olesen F. Indicators of quality in health care. Eur J Gen Pract. 1997;3:103–108. doi:10.3109/13814789709160336
   Google Scholar
• Fujita K, Moles RJ, Chen TF. Quality indicators for responsible use of medicines: a systematic review. BMJ Open. 2018;8:e020437–e020437. doi:10.1136/bmjopen-2017-020437
   PubMed Web of Science ®Google Scholar
• Hermann RC, Mattke S, Somekh D, et al. Quality Indicators for International Benchmarking of Mental Health Care. Int J Qual Health Care. 2006;18(Suppl 1):31–38. doi:10.1093/intqhc/mzl025
   PubMed Web of Science ®Google Scholar
• Fastbom J, Johnell K. National indicators for quality of drug therapy in older persons: the Swedish Experience from the first 10 years. Drugs Aging. 2015;32:189–199. doi:10.1007/s40266-015-0242-4
   PubMed Web of Science ®Google Scholar
• Scottish Government Model of Care Polypharmacy Working Group. Polypharmacy Guidance (2nd Edition) 2015. Available from: https://www.sehd.scot.nhs.uk/publications/dc20150415polypharmacy.pdf. Accessed March 31, 2021.
   Google Scholar
• NSW Therapeutic Advisory Group. Inappropriate Polypharmacy Risk Assessment Tool (IPRAT) 2020. Available from: https://www.nswtag.org.au/wp-content/uploads/2020/11/Resource-Kit-for-Measuring-Strategies-to-Reduce-Harm-from-Polypharmacy_Nov2020.pdf. Accessed March 31, 2021.
   Google Scholar
• Mendelson A, Kondo K, Damberg C, et al. The effects of pay-for-performance programs on health, health care use, and processes of care: a systematic review. Ann Intern Med. 2017;166:341–353. doi:10.7326/M16-1881
   PubMed Web of Science ®Google Scholar
• van den Berg MJ, Kringos DS, Marks LK, Klazinga NS. The Dutch health care performance report: seven years of health care performance assessment in the Netherlands. Health Res Policy Syst. 2014;12:1. doi:10.1186/1478-4505-12-1
   PubMed Web of Science ®Google Scholar
• Teichert M, Schoenmakers T, Kylstra N, et al. Quality Indicators for Pharmaceutical Care: a Comprehensive Set with National Scores for Dutch Community Pharmacies. Int J Clin Pharm. 2016;38:870–879. doi:10.1007/s11096-016-0301-x
   PubMed Web of Science ®Google Scholar
• Warholak TL, West D, Holdford DA. The educating pharmacy students and pharmacists to improve quality program: tool for pharmacy practice. J Am Pharm Assoc (2003). 2010;50:534–538. doi:10.1331/JAPhA.2010.10019
   PubMed Web of Science ®Google Scholar
• Heath I, Hippisley-Cox J, Smeeth L. Measuring performance and missing the point? BMJ. 2007;335:1075–1076. doi:10.1136/bmj.39377.387373.AD
   PubMed Web of Science ®Google Scholar
• Pencheon D. The Good Indicators Guide: Understanding How to Use and Choose Indicators. NHS institute for Innovation and Improvement; 2008. Available from: https://fingertips.phe.org.uk/documents/The%20Good%20Indicators%20Guide.pdf. Accessed March 31, 2021.
   Google Scholar
• Shea BJ, Hamel C, Wells GA, et al. Amstar is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009;62:1013–1020. doi:10.1016/j.jclinepi.2008.10.009
   PubMed Web of Science ®Google Scholar
• Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11:15. doi:10.1186/1471-2288-11-15
   PubMed Web of Science ®Google Scholar
• Viswanathan M, Patnode CD, Berkman ND, et al. Recommendations for assessing the risk of bias in systematic reviews of health-care interventions. J Clin Epidemiol. 2018;97:26–34. doi:10.1016/j.jclinepi.2017.12.004
   PubMed Web of Science ®Google Scholar
• Bühn S, Mathes T, Prengel P, et al. The risk of bias in systematic reviews tool showed fair reliability and good construct validity. J Clin Epidemiol. 2017;91:121–128. doi:10.1016/j.jclinepi.2017.06.019
   PubMed Web of Science ®Google Scholar
• Pieper D, Buechter R, Jerinic P, Eikermann M. Overviews of reviews often have limited rigor: a systematic review. J Clin Epidemiol. 2012;65:1267–1273. doi:10.1016/j.jclinepi.2012.06.015
   PubMed Web of Science ®Google Scholar
• Pieper D, Antoine SL, Mathes T, Neugebauer EA, Eikermann M. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol. 2014;67:368–375. doi:10.1016/j.jclinepi.2013.11.007
   PubMed Web of Science ®Google Scholar
• Cardona M, Stehlik P, Fawzy P, et al. Effectiveness and sustainability of deprescribing for hospitalized older patients near end of life: a systematic review. Expert Opin Drug Saf. 2021;20:81–91. doi:10.1080/14740338.2021.1853704
   PubMed Web of Science ®Google Scholar
• Kua CH, Mak VSL, Huey lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20:362–372.e11. doi:10.1016/j.jamda.2018.10.026
   PubMed Web of Science ®Google Scholar
• Shrestha S, Poudel A, Steadman K, Nissen L. Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy: a systematic review. Br J Clin Pharmacol. 2020;86:1931–1945. doi:10.1111/bcp.14113
   PubMed Web of Science ®Google Scholar
• Nakham A, Myint PK, Bond CM, Newlands R, Loke YK, Cruickshank M. Interventions to reduce anticholinergic burden in adults aged 65 and older: a systematic review. J Am Med Dir Assoc. 2020;21:172–180.e5. doi:10.1016/j.jamda.2019.06.001
   PubMed Web of Science ®Google Scholar
• Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging. 2018;35:303–319. doi:10.1007/s40266-018-0536-4
   PubMed Web of Science ®Google Scholar
• Wilsdon TD, Hendrix I, Thynne TR, Mangoni AA. Effectiveness of interventions to deprescribe inappropriate proton pump inhibitors in older adults. Drugs Aging. 2017;34:265–287. doi:10.1007/s40266-017-0442-1
   PubMed Web of Science ®Google Scholar
• Reeve E, Ong M, Wu A, et al. Review of interventions to deprescribe benzodiazepines and other hypnotics among older people. Eur J Clin Pharmacol. 2017;73:927–935. doi:10.1007/s00228-017-2257-8
   PubMed Web of Science ®Google Scholar
• Johansson T, Abuzahra ME, Keller S, et al. Impact of strategies to reduce polypharmacy on clinically relevant endpoints: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82:532–548. doi:10.1111/bcp.12959
   PubMed Web of Science ®Google Scholar
• Curtin D, Jennings E, Daunt R, et al. Deprescribing in older people approaching end of life: a randomized controlled trial using stoppfrail criteria. J Am Geriatr Soc. 2020;68:762–769. doi:10.1111/jgs.16278
   PubMed Web of Science ®Google Scholar
• New South Wales Therapeutic Advisory Group (NSW TAG) Polypharmacy Quality Use of Medicines (QUM) Indicators. Available from: https://www.nswtag.org.au/qum-indicators/. Accessed May 6, 2021.
   Google Scholar