Deprescribing in Community-Dwelling Older Adults

Importance: Deprescribing has the potential to improve patient safety and quality of care by reducing polypharmacy and potentially inappropriate medications (PIMs), which in turn may reduce adverse drug events. Questions remain about the effectiveness of deprescribing interventions in outpatient settings. Objective: To determine the association of deprescribing interventions with reducing medication count and PIMs in community-dwelling older adults. Data Sources: Included studies were English-language human studies in PubMed and the Cochrane Library published from January 2019 to July 26, 2024, and results were supplemented with reference-mining and expert consultation. Study Selection: Studies were eligible if they were solely or primarily about deprescribing, focused on community-dwelling adults, were multisite, used a randomized trial design, and reported on the primary or secondary outcome. Data Extraction and Synthesis: Two authors extracted study design, intervention characteristics, population characteristics, and follow-up. Outcomes were extracted by the statistician and checked by a second author. Meta-analyses were conducted using random effects with the Hartung-Knapp-Sidik-Jonkman method. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. Main Outcomes and Measures: The primary outcome was the number of PIMs or total medications, and the secondary outcome was proportion of persons prescribed at least 1 PIM. Results: Two authors independently screened 1586 titles from PubMed and Cochrane and 33 from other sources; 321 abstracts and 133 full-text studies were further reviewed, and disagreements were reconciled through discussion, resulting in 17 studies in 18 publications. A total of 8 studies of interventions targeting multiple medications were identified for primary outcome analysis; the random-effects pooled analysis found a mean difference of -0.14 (95% CI, -0.27 to -0.01) medications prescribed. A total of 6 studies of interventions targeting multiple medications were identified for secondary outcome analysis; the random effects pooled analysis found no significant reduction in the proportion of persons prescribed at least 1 PIM (odds ratio, 0.92 [95% CI, 0.74 to 1.14]). Conclusions and Relevance: This systematic review and meta-analysis found moderate-certainty evidence that deprescribing interventions were associated with reduced PIM and medication counts in community-dwelling older adults. While the individual-level association was very small, on an aggregated population level, the outcomes may be large, given the high prevalence of polypharmacy and PIMs in community-dwelling older adults.