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

Amy T. Page, Rhonda M. Clifford, Kathleen Potter, Darren Schwartz, Christopher D. Etherton-Beer

    Research output: Contribution to journalReview article

    102 Citations (Scopus)

    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.
    Original languageEnglish
    Pages (from-to)583–623
    JournalBritish Journal of Clinical Pharmacology
    Volume82
    Issue number3
    Early online date13 Jun 2016
    DOIs
    Publication statusPublished - Sep 2016

    Fingerprint

    Meta-Analysis
    Mortality
    Health
    Polypharmacy
    Deprescriptions
    Drug-Related Side Effects and Adverse Reactions
    Quality of Life
    Research Personnel
    Databases
    Psychology

    Cite this

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    title = "The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis",
    abstract = "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.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).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).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.",
    author = "Page, {Amy T.} and Clifford, {Rhonda M.} and Kathleen Potter and Darren Schwartz and Etherton-Beer, {Christopher D.}",
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    AU - Page, Amy T.

    AU - Clifford, Rhonda M.

    AU - Potter, Kathleen

    AU - Schwartz, Darren

    AU - Etherton-Beer, Christopher D.

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    N2 - 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.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).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).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.

    AB - 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.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).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).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.

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    M3 - Review article

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    JO - British Journal Clinical Pharmacology

    JF - British Journal Clinical Pharmacology

    SN - 0306-5251

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    ER -