TY - JOUR
T1 - Deprescribing interventions in older adults
T2 - An overview of systematic reviews
AU - Chua, Shiyun
AU - Todd, Adam
AU - Reeve, Emily
AU - Smith, Susan M.
AU - Fox, Julia
AU - Elsisi, Zizi
AU - Hughes, Stephen
AU - Husband, Andrew
AU - Langford, Aili
AU - Merriman, Niamh
AU - Harris, Jeffrey R.
AU - Devine, Beth
AU - Gray, Shelly L.
AU - the Expert Panel
N1 - Funding Information:
This study was supported by National Institute on Aging (NIA: 1R24AG064025, MPI Steinman, Boyd; SG Co-investigator). www.nia.nih. gov. The views expressed are those of the author (s) and not necessarily those of the NIA. The funders had no role in considering the study design or in the collection, analysis, and interpretation of data, the writing of the report, or the decision to submit the article for publication. ER and AL was supported by an Australian National Health and Medical Research Council (NHMRC) Investigator Grant (APP1195460). NM was supported by Health Research Board Collaboration in Ireland for Clinical Effectiveness Reviews Award (HRB-CICER-2016-1871). We would like to acknowledge the expert panel members as authors that provided input during the design phase, interpretation of results and reviewed an early and final draft. Affiliations are at the time the work was conducted. The expert panel includes: Kenneth Boockvar, MD, James J. Peters Veterans Affairs Medical Center, Bronx, NY; Holly Holmes, MD, MS, University of Texas MD Anderson Cancer Center, Houston, TX; Jean Kutner, MD, MSPH, University of Colorado School of Medicine, Denver, CO; Sunny Linnebur, PharmD, CGP, University of Colorado School of Pharmacy, Denver, CO; Zachary Marcum, PharmD, PhD, University of Washington School of Pharmacy, Seattle, WA; Elizabeth Phelan, MD, MS, University of Washington School of Medicine, Seattle, WA; Marianne Shaughnessy, PhD, CRNP, US Department of Veterans Affairs, DC; Sarah Szanton, Ph.D. Johns Hopkins University School of Nursing. The panel members reported no conflicts of interest. We thank Naomi Schwartz and Yuhan Huang, PhD candidate for assisting with screening of titles and abstracts and data extraction. We would also like to thank Diana Louden, MS for developing and conducting the search strategy.
Publisher Copyright:
© 2024 Public Library of Science. All rights reserved.
PY - 2024/6/17
Y1 - 2024/6/17
N2 - Objective The growing deprescribing field is challenged by a lack of consensus around evidence and knowledge gaps. The objective of this overview of systematic reviews was to summarize the review evidence for deprescribing interventions in older adults. Methods 11 databases were searched from 1st January 2005 to 16th March 2023 to identify systematic reviews. We summarized and synthesized the results in two steps. Step 1 summarized results reported by the included reviews (including meta-analyses). Step 2 involved a narrative synthesis of review results by outcome. Outcomes included medication-related outcomes (e.g., medication reduction, medication appropriateness) or twelve other outcomes (e.g., mortality, adverse events). We summarized outcomes according to subgroups (patient characteristics, intervention type and setting) when direct comparisons were available within the reviews. The quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Results We retrieved 3,228 unique citations and assessed 135 full-text articles for eligibility. Forty-eight reviews (encompassing 17 meta-analyses) were included. Thirty-one of the 48 reviews had a general deprescribing focus, 16 focused on specific medication classes or therapeutic categories and one included both. Twelve of 17 reviews meta-analyzed medication-related outcomes (33 outcomes: 25 favored the intervention, 7 found no difference, 1 favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction while for other outcomes we found primarily no evidence of an effect. Results were mixed for adverse events and few reviews reported adverse drug withdrawal events. Limited information was available for people with dementia, frailty and multimorbidity. All but one review scored low or critically low on quality assessment. Conclusion Deprescribing interventions likely resulted in medication reduction but evidence on other outcomes, in particular relating to adverse events, or in vulnerable subgroups or settings was limited. Future research should focus on designing studies powered to examine harms, patient-reported outcomes, and effects on vulnerable subgroups.
AB - Objective The growing deprescribing field is challenged by a lack of consensus around evidence and knowledge gaps. The objective of this overview of systematic reviews was to summarize the review evidence for deprescribing interventions in older adults. Methods 11 databases were searched from 1st January 2005 to 16th March 2023 to identify systematic reviews. We summarized and synthesized the results in two steps. Step 1 summarized results reported by the included reviews (including meta-analyses). Step 2 involved a narrative synthesis of review results by outcome. Outcomes included medication-related outcomes (e.g., medication reduction, medication appropriateness) or twelve other outcomes (e.g., mortality, adverse events). We summarized outcomes according to subgroups (patient characteristics, intervention type and setting) when direct comparisons were available within the reviews. The quality of included reviews was assessed using A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2). Results We retrieved 3,228 unique citations and assessed 135 full-text articles for eligibility. Forty-eight reviews (encompassing 17 meta-analyses) were included. Thirty-one of the 48 reviews had a general deprescribing focus, 16 focused on specific medication classes or therapeutic categories and one included both. Twelve of 17 reviews meta-analyzed medication-related outcomes (33 outcomes: 25 favored the intervention, 7 found no difference, 1 favored the comparison). The narrative synthesis indicated that most interventions resulted in some evidence of medication reduction while for other outcomes we found primarily no evidence of an effect. Results were mixed for adverse events and few reviews reported adverse drug withdrawal events. Limited information was available for people with dementia, frailty and multimorbidity. All but one review scored low or critically low on quality assessment. Conclusion Deprescribing interventions likely resulted in medication reduction but evidence on other outcomes, in particular relating to adverse events, or in vulnerable subgroups or settings was limited. Future research should focus on designing studies powered to examine harms, patient-reported outcomes, and effects on vulnerable subgroups.
UR - https://www.scopus.com/pages/publications/85196255862
U2 - 10.1371/journal.pone.0305215
DO - 10.1371/journal.pone.0305215
M3 - Review Article
C2 - 38885276
AN - SCOPUS:85196255862
SN - 1932-6203
VL - 19
JO - PLoS ONE
JF - PLoS ONE
IS - 6
M1 - e0305215
ER -