The efficacy of deprescribing interventions on health outcomes in people aged over 65 years: A systematic review protocol

Review question/objective: The objective of this review is to identify the effectiveness of deprescribing interventions on health-related outcomes. More specifically, the objectives are to identify: The effectiveness of deprescribing interventions on health, quality of life and mortality in older people, defined as those aged 65 years and above. Inclusion criteria: Types of participants: This review will consider studies that include people aged 65 years and older who are prescribed one or more regular medications at the beginning of the study. 65 years and older will be defined as studies where one of the following applies: •The mean participant age is 65 years or older. •Greater than 75% of participants are aged 65 years and older. •The data from people aged 65 years and older can be extracted. There will be no limitation on setting; therefore the review will include studies that are community-based, residential care, or hospital-based. Studies that include only moribund, terminal, or palliative participants will be excluded. Types of intervention(s)/phenomena of interest: This review will consider studies that evaluate deprescribing by a health professional of one or more regular prescription medications. These interventions include drug withdrawal, drug discontinuation, dose reduction and dose tapering. These will be compared to either no comparator or usual care, namely the continuation of the prescribed medication. Types of outcomes: This review will consider studies that include the following outcome measures: 1. Mortality 2. Physical Health • Physiological Measures (i.e. blood pressure, electrolytes) • Psychological Measures (i.e. Cornell Score) • Falls • Absence of adverse effects attributable to the deprescribed medicine(s) 3. Cognitive function 4. Quality of Life (by standardized measure) 5. Effect on medication regime (measured using a standard); e.g. Number of medications, Drug Burden Index score, Medication Appropriateness Index, Prescribing Quality Index 2. 6. Adverse Drug Withdrawal Events, which can be categorized into: • Emergence of a new condition • Return of the original condition • Physiological withdrawal • Idiopathic.