Article type
Year
Abstract
Background: Inappropriate polypharmacy is associated with poor outcomes including mortality in older adults. It is not clear whether polypharmacy is a cause or an indicator of poorer outcomes or whether reducing polypharmacy by deprescribing can improve outcomes.
Objectives: To compare in older adults the effect of reducing polypharmacy versus usual care on mortality.
Methods: We included all randomised controlled trials where the stated intention or the effect of the intervention was to reduce polypharmacy and where mortality was reported in all groups. Published and unpublished articles were found with EbscoHost (CINAHL Plus, Health Source: Nursing/Academic Edition, Academic Search Premier), Ovid (MEDLINE, DARE), Scopus and Web of Science databases from inception to February 2015. Two investigators screened papers, extracted data, and assessed the risk of bias. We combined the data using the Mantel-Haenszel method using the fixed-effect model unless statistical heterogeneity was detected (I2 ≤ 50%), when data were pooled using the random-effects model. These data comprise a subset of a larger review prospectively registered with the Joanna Briggs Institute.
Results: Eight studies met the inclusion criteria: seven open-label and one single-blind study that randomised 1898 participants with a weighted mean age of 79.3 ± 3.2 years. Set in hospital (766 participants, 3 studies), community (896 participants, 3 studies) and residential aged care (236 participants, 3 studies), the mean follow-up duration was 11.1 ± 3.8 months. Mortality was significantly reduced in the intervention group (odds ratio 0.67, 95% confidence interval 0.48 to 0.93; P value 0.02; I2 = 0%).
Conclusions: This analysis suggests that deprescribing reduces mortality in people aged over 65 years. Reducing the overall number of medicines that older people take may improve survival. More research is needed to know which individual medicines can be safely deprescribed, processes to withdraw medicines safely, and what adverse drug withdrawal effects may be expected. High-quality large studies in deprescribing are urgently needed to confirm its effect on mortality.
Objectives: To compare in older adults the effect of reducing polypharmacy versus usual care on mortality.
Methods: We included all randomised controlled trials where the stated intention or the effect of the intervention was to reduce polypharmacy and where mortality was reported in all groups. Published and unpublished articles were found with EbscoHost (CINAHL Plus, Health Source: Nursing/Academic Edition, Academic Search Premier), Ovid (MEDLINE, DARE), Scopus and Web of Science databases from inception to February 2015. Two investigators screened papers, extracted data, and assessed the risk of bias. We combined the data using the Mantel-Haenszel method using the fixed-effect model unless statistical heterogeneity was detected (I2 ≤ 50%), when data were pooled using the random-effects model. These data comprise a subset of a larger review prospectively registered with the Joanna Briggs Institute.
Results: Eight studies met the inclusion criteria: seven open-label and one single-blind study that randomised 1898 participants with a weighted mean age of 79.3 ± 3.2 years. Set in hospital (766 participants, 3 studies), community (896 participants, 3 studies) and residential aged care (236 participants, 3 studies), the mean follow-up duration was 11.1 ± 3.8 months. Mortality was significantly reduced in the intervention group (odds ratio 0.67, 95% confidence interval 0.48 to 0.93; P value 0.02; I2 = 0%).
Conclusions: This analysis suggests that deprescribing reduces mortality in people aged over 65 years. Reducing the overall number of medicines that older people take may improve survival. More research is needed to know which individual medicines can be safely deprescribed, processes to withdraw medicines safely, and what adverse drug withdrawal effects may be expected. High-quality large studies in deprescribing are urgently needed to confirm its effect on mortality.