A narrative review of the safety concerns of deprescribing in older adults and strategies to mitigate potential harms

Abstract

As with prescribing or continuing medications, deprescribing brings with it the potential for harm as well as benefit. Uncertainty and avoidance of harm has been reported as a barrier to deprescribing in practice and may contribute to continuation of inappropriate medications. Areas covered: This narrative review covers four main safety concerns/potential harms of deprescribing in older adults: adverse drug withdrawal events, return of medical condition(s), reversal of drug-drug interactions and damage to the doctor-patient relationship. These are discussed in relation to medications in general, with some examples of medication classes used to illustrate the potential safety concerns. The majority of these harms can be minimized or even prevented by using a patient-centered, structured deprescribing process with planning, tapering and close monitoring during, and after medication withdrawal. Expert opinion: More research is needed into the safety concerns of deprescribing, however, avenues exist during drug development and post-marketing surveillance to gain knowledge on this topic. Questions remain about when it is suitable to discontinue certain medications/medication classes and there is uncertainty about the harms and benefits of both medication continuation and discontinuation in complex older adults.

Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy: A Systematic Review

“…Eleven of the tools developed have not been tested in clinical practice. Therefore, it is unclear whether using these tools is likely to result in a meaningful reduction in inappropriate medication use and improve outcomes, or even cause harm . A previous review also noted this limitation .…”

“…Therefore, it is unclear whether using these tools is likely to result in a meaningful reduction in inappropriate medication use and improve outcomes, or even cause harm. 53 A previous review also noted this limitation. 16 Lack of clinical outcome data and inconsistency in outcome measurement have also been highlighted as limitations in deprescribing studies.…”

Perspectives of residential aged care facilities' staff on the identification and recording of residents' medication‐related goals of care

“…For example, a person nearing the end of life may elect to cease preventative treatments in favour of reducing adverse drug events and optimising their quality of life . Also, discussions about residents' preferences for medications and attitudes towards deprescribing can guide shared decision‐making between consumers and health‐care professionals to facilitate medication optimisation …”

“…8 Also, discussions about residents' preferences for medications and attitudes towards deprescribing can guide shared decision-making between consumers and health-care professionals to facilitate medication optimisation. 9 In Australia, RACFs are required to meet the Aged Care Quality Standards (ACQS) for the provision of quality aged care to acquire accreditation. 10 Recent changes in the ACQS require that the resident's condition, needs and preferences | e135 SAWAN et Al. for clinical care are documented and communicated within the organisation and with others where responsibility for care is shared.…”

Deprescribing one year on: challenging the first iatrogenic epidemic

“…It is important to be mindful of concerns around deprescribing, and a narrative review of safety concerns with deprescribing13 identified four categories of concern. These included withdrawal (adverse) effects, recurrence of condition, consequences of change to drug interactions and negative impact on the patient–doctor relationship.…”