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A systematic review of the evidence for deprescribing interventions among older people living with frailty.
BMC Geriatr. 2021 04 17; 21(1):258.BG

Abstract

BACKGROUND

Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.

METHODS

The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists.

RESULTS

Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79-87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving.

CONCLUSION

There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations.

TRIAL REGISTRATION

The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367 .

Links

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Authors+Show Affiliations

Ibrahim K
Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK. k.ibrahim@soton.ac.uk. NIHR Applied Research Collaboration Wessex, Southampton, UK. k.ibrahim@soton.ac.uk.
Cox NJ
Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK. Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK.
Stevenson JM
Institute of Pharmaceutical Science, King's College London, London, UK. Pharmacy Department, Guy's and St. Thomas' NHS FT, London, UK.
Lim S
Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK. NIHR Applied Research Collaboration Wessex, Southampton, UK.
Fraser SDS
NIHR Applied Research Collaboration Wessex, Southampton, UK. Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK.
Roberts HC
Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK. NIHR Applied Research Collaboration Wessex, Southampton, UK. Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS FT, Southampton, UK.

MeSH

AgedAged, 80 and overDeprescriptionsFrailtyHumansPolypharmacyPotentially Inappropriate Medication ListQuality of Life

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

33865310

Citation

Ibrahim, Kinda, et al. "A Systematic Review of the Evidence for Deprescribing Interventions Among Older People Living With Frailty." BMC Geriatrics, vol. 21, no. 1, 2021, p. 258.
Ibrahim K, Cox NJ, Stevenson JM, et al. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatr. 2021;21(1):258.
Ibrahim, K., Cox, N. J., Stevenson, J. M., Lim, S., Fraser, S. D. S., & Roberts, H. C. (2021). A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatrics, 21(1), 258. https://doi.org/10.1186/s12877-021-02208-8
Ibrahim K, et al. A Systematic Review of the Evidence for Deprescribing Interventions Among Older People Living With Frailty. BMC Geriatr. 2021 04 17;21(1):258. PubMed PMID: 33865310.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A systematic review of the evidence for deprescribing interventions among older people living with frailty. AU - Ibrahim,Kinda, AU - Cox,Natalie J, AU - Stevenson,Jennifer M, AU - Lim,Stephen, AU - Fraser,Simon D S, AU - Roberts,Helen C, Y1 - 2021/04/17/ PY - 2020/11/17/received PY - 2021/04/08/accepted PY - 2021/4/18/entrez PY - 2021/4/19/pubmed PY - 2021/4/27/medline KW - Deprescribing KW - Frailty KW - Inappropriate medications KW - Medication review KW - Polypharmacy SP - 258 EP - 258 JF - BMC geriatrics JO - BMC Geriatr VL - 21 IS - 1 N2 - BACKGROUND: Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty. METHODS: The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists. RESULTS: Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79-87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving. CONCLUSION: There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations. TRIAL REGISTRATION: The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367 . SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/33865310/A_systematic_review_of_the_evidence_for_deprescribing_interventions_among_older_people_living_with_frailty_ DB - PRIME DP - Unbound Medicine ER -