Appropriate deprescribing in older people

Appropriate deprescribing in older people: a challenging necessity

Older people are often taking several medications for a number of different medical conditions.  Although physicians prescribe medications to treat diseases and symptoms, there may be also harmful side effects, especially so in older people taking several medications. Unfortunately, regular review of the benefits or risks of prescribed medications is as of yet not part of standard care. Also, data on how and in whom to stop medications in older people is scarce. The reason this is an important area of work is that medication-related issues in older people are a common cause of harm, including both expected and unexpected effects of medications. Research to date tells us that to ensure successful implementation of structured and appropriate deprescribing, careful planning within hospital systems is needed. This includes involving different members of the team to ensure the patients truly benefit. This themed collection offers key articles providing tools to assist decision-making, implementation strategies, and multi-disciplinary interventions – all with the aim of improving patient outcomes and sustainability of deprescribing approaches.

A full commentary has been published in Age and Ageing to accompany this collection.

POLYPHARMACY AND DEPRESCRIBING

1. Potentially inappropriate prescribing in dementia, multi-morbidity and incidence of adverse health outcomes. João Delgado, Lindsay Jones, Marie C Bradley, Louise M Allan, Clive Ballard, Linda Clare, Richard H Fortinsky, Carmel M Hughes, David Melzer

2. Use of medication among nursing home residents: a Danish drug utilisation study. Carina Lundby, John Jensen, Søren Post Larsen, Helene Hoffmann, Anton Pottegård, Mette Reilev

PRACTICAL DEPRESCRIBING TOOLS

3. STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Denis O'Mahony, David O'Sullivan, Stephen Byrne, Marie Noelle O'Connor, Cristin Ryan, Paul Gallagher

4. VALFORTA: a randomised trial to validate the FORTA (Fit fOR The Aged) classification. Martin Wehling, Heinrich Burkhardt, Alexandra Kuhn-Thiel, Farhad Pazan, Christina Throm, Christel Weiss, Helmut Frohnhofen

5. Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2. Denis Curtin, Paul Gallagher, Denis O’Mahony

6. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drugs. Lotta J Seppala, Mirko Petrovic, Jesper Ryg, Gulistan Bahat, Eva Topinkova, Katarzyna Szczerbińska, Tischa J M van der Cammen, Sirpa Hartikainen, Birkan Ilhan, Francesco Landi, Yvonne Morrissey, Alpana Mair, Marta Gutiérrez-Valencia, Marielle H Emmelot-Vonk, María Ángeles Caballero Mora, Michael Denkinger, Peter Crome, Stephen H D Jackson, Andrea Correa-Pérez, Wilma Knol, George Soulis, Adalsteinn Gudmundsson, Gijsbertus Ziere, Martin Wehling, Denis O’Mahony, Antonio Cherubini, Nathalie van der Velde

IMPLEMENTATION IN CLINICAL PRACTICE

7. Medication appropriateness on an acute geriatric care unit: the impact of the removal of a clinical pharmacist. The Investigators of the MAGIC-PHARM Study, Michael Khazaka, Jeanne Laverdière, Chen Chen Li, Florence Correal, Louise Mallet, Mariane Poitras, Patrick Viet-Quoc Nguyen

8. The effect of biannual medication reviews on the appropriateness of psychotropic drug use for neuropsychiatric symptoms in patients with dementia: a randomised controlled trial. Klaas van der Spek, Raymond T C M Koopmans, Martin Smalbrugge, Marjorie H J M G Nelissen-Vrancken, Roland B Wetzels, Claudia H W Smeets, Erica de Vries, Steven Teerenstra, Sytse U Zuidema, Debby L Gerritsen

BARRIERS AND FACILITATORS

9. Computerised interventions designed to reduce potentially inappropriate prescribing in hospitalised older adults: a systematic review and meta-analysis. Kieran Dalton, Gary O’Brien, Denis O’Mahony, Stephen Byrne

10. Prevention of adverse drug reactions in hospitalized older patients with multi-morbidity and polypharmacy: the SENATOR* randomized controlled clinical trial. Denis O'Mahony, Adalsteinn Gudmundsson, Roy L Soiza, Mirko Petrovic, Alfonso Jose Cruz-Jentoft, Antonio Cherubini, Richard Fordham, Stephen Byrne, Darren Dahly, Paul Gallagher, Amanda Lavan, Denis Curtin, Kieran Dalton, Shane Cullinan, Evelyn Flanagan, Frances Shiely, Olafur Samuelsson, Astros Sverrisdottir, Selvarani Subbarayan, Lore Vandaele, Eline Meireson, Beatriz Montero-Errasquin, Aurora Rexach-Cano, Andrea Correa Perez, Isabel Lozano-Montoya, Manuel Vélez-Díaz-Pallarés, Annarita Cerenzia, Samanta Corradi, Maria Soledad Cotorruelo Ferreiro, Federica Dimitri, Paolo Marinelli, Gaia Martelli, Rebekah Fong Soe Khioe, Joseph Eustace

11. Computer-generated STOPP/START recommendations for hospitalised older adults: evaluation of the relationship between clinical relevance and rate of implementation in the SENATOR trial. Kieran Dalton, Denis Curtin, Denis O’Mahony, Stephen Byrne

12. A practitioner behaviour change intervention for deprescribing in the hospital setting. Sion Scott, Helen May, Martyn Patel, David J Wright, Debi Bhattacharya

SHARED DECISION MAKING

13. In-hospital adverse drug reactions in older adults; prevalence, presentation and associated drugs—a systematic review and meta-analysis. Emma L M Jennings, Kevin D Murphy, Paul Gallagher, Denis O’Mahony

14. ‘They must help if the doctor gives them to you’: a qualitative study of the older person’s lived experience of medication-related problems. Nikesh Parekh, Beatrice Gahagan, Lizzie Ward, Khalid Ali

15. The prevalence and impact of potentially inappropriate prescribing among older persons in primary care settings: multilevel meta-analysis. Tau Ming Liew, Cia Sin Lee, Shawn Kuan Liang Goh, Zi Ying Chang

Browse the full library of themed collections on the Age and Ageing website.