As we get older, we tend to accumulate medications that have been prescribed over the course of adulthood, often leading to polypharmacy (defined as taking five or more medications concurrently).
Research in 2017 found that almost a million Australians over the age of 70 were affected by polypharmacy – with women more likely to be using multiple medications than men.
Polypharmacy is linked to increased risks of side effects, medication errors, interactions and poor medication adherence. But are there risks associated with reducing polypharmacy?
In a new study, Western Australia researchers updated a 2016 systematic review and performed a meta-analysis looking at deprescribing and found that careful deprescribing can improve survival rates in older people.
Researchers looked at participants 65 years and older in studies from 2015 to 2024, specifically focussed on deprescribing (rather than optimising medications, which is more about adding or changing medications). 259 studies were included, of which 95 were randomised controlled trials (RCTs).
Data mostly came from the United States, Canada, the United Kingdom and Australia. A subgroup analysis was also performed, looking at the age of the participants and the different types of intervention (deprescribing single medications vs multiple medications).
The data from RCTs showed that deprescribing had a survival benefit when implemented in people aged 65-79.
The research highlights the value of regular and proactive medication review, with the aim of deprescribing to reduce inappropriate polypharmacy. Such changes often occur on an ad-hoc basis, such as during unplanned hospital admissions, but could have a significant benefit if conducted routinely and early on once patients reach the age of 65.
While the authors acknowledge that there can be issues posed by deprescribing – such as the exacerbation of symptoms or rebound phenomena, which need to be managed with a tailored and patient-specific approach.
Further information
The effect of deprescribing interventions on mortality and health outcomes in older people – An updated systematic review and meta-analysis: British Journal of Pharmacology
