How “age-friendly” are deprescribing interventions? A scoping review of deprescribing trials

Jinjiao Wang, Jenny Y. Shen, Yeates Conwell, Eric J. Podsiadly, Thomas V. Caprio, Kobi Nathan, Fang Yu, Erika E. Ramsdale, Donna M. Fick, Amanda S. Mixon, Sandra F. Simmons

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: To assess how age-friendly deprescribing trials are regarding intervention design and outcome assessment. Reduced use of potentially inappropriate medications (PIMs) can be addressed by deprescribing—a systematic process of discontinuing and/or reducing the use of PIMs. The 4Ms—“Medication”, “Mentation”, “Mobility”, and “What Matters Most” to the person—can be used to guide assessment of age-friendliness of deprescribing trials. Data Source: Published literature. Study Design: Scoping review. Data Extraction Methods: The literature was identified using keywords related to deprescribing and polypharmacy in PubMed, EMBASE, Web of Science, ProQuest, CINAHL, and Cochrane and snowballing. Study characteristics were extracted and evaluated for consideration of 4Ms. Principal Findings: Thirty-seven of the 564 trials identified met the review eligibility criteria. Intervention design: “Medication” was considered in the intervention design of all trials; “Mentation” was considered in eight trials; “Mobility” (n = 2) and “What Matters Most” (n = 6) were less often considered in the design of intervention. Most trials targeted providers without specifying how matters important to older adults and their families were aligned with deprescribing decisions. Outcome assessment: “Medication” was the most commonly assessed outcome (n = 33), followed by “Mobility” (n = 13) and “Mentation” (n = 10) outcomes, with no study examining “What Matters Most” outcomes. Conclusions: “Mentation” and “Mobility”, and “What Matters Most” have been considered to varying degrees in deprescribing trials, limiting the potential of deprescribing evidence to contribute to improved clinical practice in building an age-friendly health care system.

Original languageEnglish (US)
Pages (from-to)123-138
Number of pages16
JournalHealth Services Research
Volume58
Issue numberS1
DOIs
StatePublished - Feb 2023

Keywords

  • age-friendly health systems
  • deprescribing
  • empirical typology
  • polypharmacy
  • review

ASJC Scopus subject areas

  • Health Policy

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