Abstract
AbstractWe conduct a systematic review to investigate current deprescribing practices and evaluate outcomes and adverse events with deprescribing of preventive medications in older patients with either an end-of-life designation or residing in long-term care facilities with cardiometabolic conditions. Studies were identified using a literature search of MEDLINE, EMBASE, Web of Science, clinicaltrials.gov.uk, CINAHLS, and the Cochrane Register from inception to March 2022. Studies reviewed included observational studies and randomised control trials (RCTs). Data was extracted on baseline characteristics, deprescribing rates, adverse events and outcomes, and quality of life indicators, and was discussed using a narrative approach. Thirteen studies were identified for inclusion. Deprescribing approaches included complete withdrawal, dose reduction or tapering, or switching to an alternative medication, for at least one preventive medication. Deprescribing success rates ranged from 27 to 94.7%. The studies reported no significant changes in laboratory values or adverse outcomes but did find mixed outcomes for hospitalisations and a slight increase in mortality rates when comparing the intervention and control groups. Lack of good-quality randomised control trials suggests that deprescribing in the older population residing in long-term care facilities with cardiometabolic conditions and multimorbidity is feasible when controlled and regularly monitored by an appropriate healthcare clinician, and that the benefits outweigh the potential harm in this cohort of patients. Due to the limited evidence and the heterogeneity of studies, a meta-analysis was not performed and as such further research is required to assess the benefits of deprescribing in this patient population. Systematic review registration: PROSPERO CRD42021291061.
Publisher
Springer Science and Business Media LLC
Subject
Geriatrics and Gerontology,Aging
Reference36 articles.
1. World Health Organisation, Cardiovascular diseases, 2022. [Online]. Available: https://www.who.int/health-topics/cardiovascular-diseases#tab=tab_1. Accessed 21 September 2022.
2. Leon BM, Maddox TM. Diabetes and cardiovascular disease: epidemiology, biological mechanisms, treatment recommendations and future research. World J Diabetes. 2015;6(13):1246–58.
3. Hambling CE, Khunti K, Cos X, Wens J, Martinez L, Topsever P, Del Prato S, Sinclair A, Schernthaner G, Rutten G, Seidu S. Factors influencing safe glucose lowering in older adults with type 2 diabetes: a PeRsOn-centred ApproaCh to IndiVidualisEd (PROACTIVE) glycaemic goals for older people: a position statement of Primary Care Diabetes Europe. Prim Care Diabetes. 2019;13(4):330–52.
4. Waterman BJ. A person-centred approach to determining target HbA1c for older people with diabetes. Diabetes Prim Care. 2012;14(1):22–33.
5. Rowcroft Hospice. Guidelines for mangement of diabetes in palliative care patients, July 2013. [Online]. Available: https://rowcrofthospice.org.uk/wp-content/uploads/RH-diabetic-guidelines-jul2013_2-1.pdf. Accessed 17 April 2023.