Outcomes of deprescribing interventions in older patients with life-limiting illness and limited life expectancy : a systematic review

Article indépendant

SHRESTHA, Shakti | POUDEL, Arjun | STEADMAN, Kathryn | NISSEN, Lisa

AIMS: Older patients with life-limiting illness (LLI) and limited life expectancy (LLE) continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary. However, deprescribing in this population can be complex and challenging. Therefore, we aimed to investigate the evidence for outcomes of deprescribing interventions in older patients with LLI and LLE. METHODS: Studies on deprescribing intervention and their outcomes in age =65 years with LLI and LLE were searched using PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO and Google Scholar. Medication appropriateness was primary outcome, while clinical and cost-related outcomes were secondary. Eligibility, data extraction and quality assessment were followed by a narrative synthesis of data. RESULTS: Of nine studies (1371 participants), three reported on primary outcome. One study showed a significant reduction in medication inappropriateness by 34.9% (p<0.001) from admission to close-out, the second achieved 29.4% (p<0.001) and 15.1% (p=0.003) reduction at 12 and 24 months respectively. The third reported that their intervention stopped (17.2%) and altered the dose (2.6%) of high risk medications. Commonly reported clinical outcomes were mortality (n=3), quality of life (n=2) and falls (n=2). Outcomes in terms of cost were reported as overall cost (n=2), medication cost (n=1) and health care expenditure (n=1). CONCLUSIONS: Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness, and has potential for enhancement of several clinical outcomes and cost savings, but the evidence needs to be better established.

http://dx.doi.org/10.1111/bcp.14113

Voir la revue «British journal of clinical pharmacology»

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