A pilot randomized controlled trial of deprescribing

Abstract

Abstract:Objective: Polypharmacy and adverse drug reactions are frequent and important among older people. Few clinical trials have evaluated systematic withdrawal of medications among older people. This small, open, study was conducted to determine the feasibility of a randomized controlled deprescribing trial. Methods: Ten volunteers living in the community (recruited by media advertising) and 25 volunteers living in residential aged-care facilities (RCFs) were randomized to intervention or control groups. The intervention was gradual withdrawal of one target medication. The primary outcome was the number of intervention participants in whom medication withdrawal could be achieved. Other outcomes measures were quality of life, medication adherence, sleep quality, and cognitive impairment. Results: Participants were aged 80±11 years and were taking 9±2 medications. Fifteen participants commenced medication withdrawal and all ceased or reduced the dose of their target medication. Two subjects withdrew; one was referred for clinical review, and one participant declined further dose reductions. Conclusions: A randomized controlled trial of deprescribing was acceptable to participants. Recruitment in RCFs is feasible. Definitive trials of deprescribing are required.

Optimizing drug therapy in patients with advanced dementia: A patient-centered approach

“…This reduction was primarily seen amongst medications for primary prevention. These results are consistent with other studies in frail elderly patients in other healthcare settings [20][21][22]. A program to address polypharmacy in elderly community dwelling patients resulted in an average decrease of 4.4 medication per patient [21] whereas an intervention in a geriatric specialty hospital decreased medications by 47% (2.8) per patient [20].…”

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

“…Several studies have shown that systematic deprescribing may be feasible [6][7][8][9], however, the translation of these into practice may be limited due to multiple barriers. General practitioners have reported that a major barrier to optimising medication use is patient resistance to have a medication ceased [10].…”

Deprescribing

“…3 This is further supported by a recent Australian pilot study which confirmed the feasibility of deprescribing in polypharmacy. 4 …”