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

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.

Keywords: deprescribing; medication discontinuation; meta-analysis; older adults; polypharmacy; systematic review.

© 2016 The British Pharmacological Society.

Figures

Figure 1

Selection process for included papers

Figure 2

Risk of bias graph for all included randomized studies. Low risk of bias, unclear risk of bias, high risk of bias

Figure 3

Mortality associated with deprescribing interventions to reduce polypharmacy (randomized studies)

Figure 4

Mortality associated with deprescribing interventions to reduce polypharmacy for subgroup analysis based on intervention technique (randomized studies)

Figure 5

Mortality associated with deprescribing interventions to reduce polypharmacy for subgroup analysis based on age (randomized studies)

Figure 6

Mortality associated with deprescribing interventions to reduce polypharmacy for subgroup analysis for participants living with dementia and cognitively intact participants (randomized studies)