International Journal of General Medicine (Jul 2021)
Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions
Abstract
Harry Wu,1 Lisa Kouladjian O’Donnell,1 Kenji Fujita,1 Nashwa Masnoon,1,2 Sarah N Hilmer1 1Departments of Clinical Pharmacology and Aged Care, Faculty of Medicine and Health, The University of Sydney, Kolling Institute, Royal North Shore Hospital, Sydney, NSW, Australia; 2Department of Pharmacy, Royal North Shore Hospital, St Leonards, NSW, AustraliaCorrespondence: Sarah N HilmerLevel 13, Kolling Institute of Medical Research, Royal North Shore Hospital, Reserve Road, St Leonards, NSW, 2065, AustraliaTel +612 9926 4481Email [email protected]: Polypharmacy is a major challenge in healthcare for older people, and is associated with increased risks of adverse outcomes, such as delirium, falls, frailty, cognitive impairment and hospitalization. There is significant public and professional interest in the role of deprescribing in reducing medication-related harms in older people. We aim to provide a narrative review of 1) the safety and efficacy of deprescribing interventions, 2) the challenges and solutions of deprescribing research and implementation in clinical practice, and 3) the benefits of using Computerized Clinical Decision Support Systems (CCDSS) and Quality Indicators (QIs) in deprescribing research and practice. Deprescribing is an established management strategy to minimize polypharmacy and potentially inappropriate medications. There is limited clinical evidence for its efficacy on global and geriatric outcomes. Various challenges at patient, healthcare professional and healthcare system levels may impact on the success of deprescribing interventions in research and practice. Management strategies that target all levels of the healthcare system are required to overcome these challenges. Future studies may consider large multicenter prospective designs to establish the effects and sustainability of deprescribing interventions on clinical outcomes.Keywords: deprescribing, polypharmacy, geriatric, older people, computerized clinical decision support, quality indicator
