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

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...

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Published inBritish 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
LanguageEnglish
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
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Abstract 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.
AbstractList 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.
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.AIMSDeprescribing 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.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).METHODSSpecified 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).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).RESULTSA 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).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.CONCLUSIONSAlthough 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.
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. 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). 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). 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.
Author Clifford, Rhonda M.
Potter, Kathleen
Schwartz, Darren
Etherton‐Beer, Christopher D.
Page, Amy T.
AuthorAffiliation 2 Royal Perth Hospital Perth Western Australia Australia
3 Graylands Hospital Mt Claremont Western Australia Australia
1 School of Medicine and Pharmacology University of Western Australia 35 Stirling Highway Crawley 6009 Western Australia Australia
AuthorAffiliation_xml – name: 1 School of Medicine and Pharmacology University of Western Australia 35 Stirling Highway Crawley 6009 Western Australia Australia
– name: 3 Graylands Hospital Mt Claremont Western Australia Australia
– name: 2 Royal Perth Hospital Perth Western Australia Australia
Author_xml – sequence: 1
  givenname: Amy T.
  orcidid: 0000-0002-2084-8469
  surname: Page
  fullname: Page, Amy T.
  organization: University of Western Australia
– sequence: 2
  givenname: Rhonda M.
  surname: Clifford
  fullname: Clifford, Rhonda M.
  organization: University of Western Australia
– sequence: 3
  givenname: Kathleen
  surname: Potter
  fullname: Potter, Kathleen
  organization: University of Western Australia
– sequence: 4
  givenname: Darren
  surname: Schwartz
  fullname: Schwartz, Darren
  organization: Graylands Hospital
– sequence: 5
  givenname: Christopher D.
  orcidid: 0000-0001-5148-0188
  surname: Etherton‐Beer
  fullname: Etherton‐Beer, Christopher D.
  organization: Royal Perth Hospital
BackLink https://www.ncbi.nlm.nih.gov/pubmed/27077231$$D View this record in MEDLINE/PubMed
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older adults
deprescribing
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medication discontinuation
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e_1_2_9_47_1
e_1_2_9_132_1
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e_1_2_9_170_1
e_1_2_9_74_1
e_1_2_9_51_1
e_1_2_9_78_1
e_1_2_9_13_1
e_1_2_9_32_1
e_1_2_9_55_1
e_1_2_9_97_1
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e_1_2_9_36_1
e_1_2_9_59_1
e_1_2_9_142_1
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e_1_2_9_86_1
e_1_2_9_7_1
e_1_2_9_82_1
e_1_2_9_3_1
e_1_2_9_112_1
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Snippet Aims Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether...
Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not...
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SubjectTerms deprescribing
Deprescriptions
Humans
Inappropriate Prescribing - adverse effects
Inappropriate Prescribing - mortality
medication discontinuation
meta‐analysis
older adults
Polypharmacy
Systematic Review
Systematic Reviews
Title The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis
URI https://onlinelibrary.wiley.com/doi/abs/10.1111%2Fbcp.12975
https://www.ncbi.nlm.nih.gov/pubmed/27077231
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