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J Am Med Dir Assoc. 2018 Dec 20. pii: S1525-8610(18)30606-6. doi: 10.1016/j.jamda.2018.10.026. [Epub ahead of print]

Health Outcomes of Deprescribing Interventions Among Older Residents in Nursing Homes: A Systematic Review and Meta-analysis.

Author information

1
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia. Electronic address: chong.kua@monash.edu.
2
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
3
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia; Asian Centre for Evidence Synthesis in Population, Implementation and Clinical Outcomes (PICO), Health and Well-being Cluster, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia; Gerentechnology Laboratory, Global Asia in the 21st Century (GA21) Platform, Monash University Malaysia, Bandar Sunway, Malaysia; School of Pharmacy, Taylor's University Lakeside Campus, Subang Jaya, Selangor.

Abstract

OBJECTIVES:

Deprescribing is effective in addressing concerns relating to polypharmacy in residents of nursing homes. However, the clinical outcomes of deprescribing interventions among residents in nursing homes are not well understood. We evaluated the impact of deprescribing interventions by health care professionals on clinical outcomes among the older residents in nursing homes.

DESIGN:

Systematic review and meta-analysis of randomized controlled trials. CINAHL, International Pharmaceutical Abstracts, MEDLINE, EMBASE, and Cochrane Library were searched from inception until September 2017; manual searches of reference lists of systematic reviews identified in the electronic search; and online trial registries for unpublished, ongoing, or planned trials. (PROSPERO CRD42016050028).

SETTING AND PARTICIPANTS:

Randomized controlled trials in a nursing home setting that included participants of at least 60 years of age.

MEASURES:

Falls, all-cause mortality, hospitalization, and potentially inappropriate medication were assessed in the meta-analysis.

RESULTS:

A total of 41 randomized clinical studies (18,408 residents) that examined deprescribing (defined as either medication discontinuation, substitution, or reduction) in nursing were identified. Deprescribing interventions significantly reduced the number of residents with potentially inappropriate medications by 59% (odds ratio [OR] 0.41, 95% confidence interval [CI] 0.19-0.89). In subgroup analysis, medication review-directed deprescribing interventions reduced all-cause mortality by 26% (OR 0.74, 95% CI 0.65-0.84), as well as the number of fallers by 24% (OR 0.76, 95% CI 0.62-0.93).

CONCLUSIONS:

Compared to other deprescribing interventions, medication review-directed deprescribing had significant benefits on older residents in nursing homes. Further research is required to elicit other clinical benefits of medication review-directed deprescribing practice.

KEYWORDS:

Deprescribing; falls; mortality; nursing home; older adult; polypharmacy

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