Clinical outcomes in older people of deprescribing or continuing medicines that caused a hospital admission

Medicines safety is a significant health issue for the 2.7 million Australians aged 65 years and older and at risk of adverse drug events. Older people frequently consume multiple medicines to manage one or more chronic conditions. Medicines offer great potential benefits yet carry significant risk for older people with multiple morbidities. Medicines use has nearly doubled in Australia over the past 20 years in some populations. By age 70, three out of four people who are hospitalised take five or more medicines every day. However, it is important to recognise that polypharmacy is not just a problem of too many medicines. People using five or more medicines are paradoxically more likely to be under-treated with appropriate medicines (such as indicated preventive therapies) than people taking fewer medicines. Polypharmacy appears to be a growing public health concern, and deprescribing is one intervention proposed to address the issue. Interest is growing in interventions to reverse the trend of increasing number of medications.

Deprescribing is an intervention that is acceptable to older people, with over 90% of older people stating that they would like to stop one of their medicines if their doctor said it was possible. Two meta-syntheses reported the enablers and barriers to deprescribing. Deprescribing was demonstrated to be safe in my published work including an RCT and a meta-analysis to synthesise the existing research to inform evidence based deprescribing.

Health professionals consistently cite the lack of synthesised evidence or guidance as a barrier to deprescribing. Few high quality data exist about deprescribing effects at the population level. This pharmacoepidemiological research proposed in this fellowship will contribute to knowledge and understanding of the effects of deprescribing in real-world scenarios using population-based datasets. This information will be able to highlight future strategies to inform practice, policy and research.