The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis

• Published in: British journal of clinical pharmacology Vol. 82; no. 3; pp. 583 - 623
• Main Authors: Page, Amy T., Clifford, Rhonda M., Potter, Kathleen, Schwartz, Darren, Etherton‐Beer, Christopher D.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01.09.2016
• Subjects: deprescribing; Deprescriptions; Humans; Inappropriate Prescribing - adverse effects; Inappropriate Prescribing - mortality; medication discontinuation; meta‐analysis; older adults; Polypharmacy; Systematic Review; Systematic Reviews; meta-analysis; older adults; deprescribing; systematic review; polypharmacy; medication discontinuation
• ISSN: 0306-5251; 1365-2125; 1365-2125
• DOI: 10.1111/bcp.12975

Aims Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults. Methods Specified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use). Results A total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17–0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61–1.11). Subgroup analysis revealed patient‐specific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43–0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86–1.69). Conclusions Although nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient‐specific interventions to deprescribe in randomized studies.