A concept analysis of deprescribing medications in older people

Aim: Deprescribing is an increasingly common term in the literature, although no specific accepted definition exists. We aimed to clarify the concept of deprescribing as used in research and clinical practice. 

Methods: Deprescribing was examined using the eight-step Walker and Avant method of concept analysis that consisted of: (i) concept selection; (ii) determining the purpose of the analysis; (iii) identifying uses of the concept; (iv) determining the critical attributes; (v) identifying the model case; (vi) identifying borderline and contrary cases; (vii) identifying antecedents and consequences; and (viii) defining empirical referents. A literature search was conducted on the word de?prescri*. 

Results: We identified seven critical attributes: withdrawing medications, de-escalation, intended outcomes, structured and iterative process, intervention, risk to benefit, and patient-centred care. Deprescribing antecedents were identified as changing health, changing goals for health care, and polypharmacy. Deprescribing consequences identified were compliance, health outcomes, mortality and cost, and possibility for adverse drug withdrawal events to occur. We used the model case, borderline and contrary cases and empirical referents to illustrate the concept of deprescribing. 

Conclusions: Deprescribing is a term used with varying degrees of precision, and there is no accepted definition. In this paper, we have analysed the concept of deprescribing and identified it as a patient-centred process of medication withdrawal intended to achieve improved health outcomes through discontinuation of one or more medications that are either potentially harmful or no longer required.