Deprescribing in older patients boosts appropriateness, reduces cost of drug use

Deprescribing interventions in older patients with life-limiting illness (LLI) and limited life expectancy (LLE) may improve medication appropriateness and has potential for enhancement of several clinical outcomes and cost savings, suggests a study.

“Older patients with LLI and LLE continue to receive potentially inappropriate medicines, consequently deprescribing is often necessary,” the investigators said. “However, deprescribing in this population can be complex and challenging.”

The investigators searched for studies on deprescribing intervention and their outcomes in older patients with LLI and LLE aged ≥65 years using the following databases: PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, and Google Scholar.

The primary outcome was medication appropriateness, while secondary ones included clinical and cost-related outcomes. The investigators assessed eligibility and quality of studies as well as extracted data, followed by a narrative synthesis.

Nine studies, including a total of 1,375 participants, were eligible for this systematic review, of which three reported on the primary outcome.

Medication inappropriateness was reduced by 34.9 percent (p<0.001) from admission to close-out in one study, while the second study achieved 29.4-percent (p<0.001) and 15.1-percent (p=0.003) reduction at 12 and 24 months, respectively. In the third study, deprescribing ceased (17.2 percent) and altered the dose (2.6 percent) of high-risk medications.

Of the clinical outcomes, the most reported were mortality (n=3), quality of life (n=2), and falls (n=2). Outcomes in terms of cost were reported as follows: overall cost (n=2), medication cost (n=1), and healthcare expenditure (n=1).

“Our findings suggest that deprescribing in older patients with LLI and LLE can improve medication appropriateness … clinical outcomes. and cost savings, but the evidence needs to be better established,” the investigators said.