Background: Polypharmacy and use of inappropriate medications have been linked to increased risk of falls, hospitalizations, cognitive impairment, and death. The primary objective of this review was to evaluate the effectiveness, comparative effectiveness, and harms of deprescribing interventions among community-dwelling older adults. Methods: We searched OVID MEDLINE Embase, CINAHL, and the Cochrane Library from 1990 through February 2019 for controlled clinical trials comparing any deprescribing intervention to usual care or another intervention. Primary outcomes were all-cause mortality, hospitalizations, health-related quality of life, and falls. The secondary outcome was use of potentially inappropriate medications (PIMs). Interventions were categorized as comprehensive medication review, educational initiatives, and computerized decision support. Data abstracted by one investigator were verified by another. We used the Cochrane criteria to rate risk of bias for each study and the GRADE system to determine certainty of evidence (COE) for primary outcomes. Results: Thirty-eight low and medium risk of bias clinical trials were included. Comprehensive medication review may have reduced all-cause mortality (OR 0.74, 95% CI: 0.58 to 0.95, I2 = 0, k = 12, low COE) but probably had little to no effect on falls, health-related quality of life, or hospitalizations (low to moderate COE). Nine of thirteen trials reported fewer PIMs in the intervention group. Educational interventions probably had little to no effect on all-cause mortality, hospitalizations, or health-related quality of life (low to moderate COE). The effect on falls was uncertain (very low COE). All 11 education trials that included PIMs reported fewer in the intervention than in the control groups. Two of 4 computerized decision support trials reported fewer PIMs in the intervention arms; none included any primary outcomes. Discussion: In community-dwelling people aged 65 years and older, medication deprescribing interventions may provide small reductions in mortality and use of potentially inappropriate medications. Registry Information: PROSPERO - CRD42019132420.
Bibliographical noteFunding Information:
Funding to support the VA Evidence Synthesis Program site at the Minneapolis VA was provided by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service.
Dr. Linsky was funded by grants from VA Health Services Research and Development (I21HX002406-01 and 5IK2HX001357-05). She is also a Co-Investigator for the Center for Medication Safety in Aging, a VA Patient Safety Center of Inquiry.
This manuscript is based on a Department of Veterans Affairs (VA) Evidence-based Synthesis Program report prepared for the VA Center for Medication Safety in Aging and available at https://www.hsrd.research.va.gov/publications/esp/ . The purpose of the report, which was also supported by the VA Pharmacy Benefits Management and the Geriatrics and Extended Care Services, was to inform implementation of deprescribing within VA. These services collaborate within VA to identify deprescribing best practices to improve the health of Veterans.
© 2020, Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply).
- comprehensive medication review
- older populations
PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.
- Systematic Review