title: Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes.
abstract: Different styles of interventions can reduce medication exposure in older adults. However, the evidence for their clinical effectiveness and sustainability is conflicting and lacking. There are some data to guide clinicians on which medicines are more likely to be inappropriate in older people, which medicines are more likely to cause ADWEs, and which medicines should be tapered slowly rather than stopped. To reduce the likelihood of clinically significant adverse events, clinicians should undertake a step-wise approach to discontinuing medications and do so under appropriate supervision. Further research to determine the most effective ways to discontinue medications, and to provide a better understanding of the clinical benefits of various interventions is required. Large RCTs evaluating multidisciplinary interventions and clinical outcomes of changes in medicines regimen across different settings are required to confirm the findings of the studies performed so far.
authors.affiliation: Departments of Clinical Pharmacology and Aged Care, 11C Main Building, Royal North Shore Hospital, St Leonards NSW 2065, Australia. danijela.gnjidic@sydney.edu.au
authors.forename: Danijela
authors.initials: D
authors.lastname: Gnjidic
authors.forename: David G
authors.initials: DG
authors.lastname: Le Couteur
authors.forename: Lisa
authors.initials: L
authors.lastname: Kouladjian
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
mesh_terms: D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D064420:Drug-Related Side Effects and Adverse Reactions; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010595:Pharmacists; D010820:Physicians; D019338:Polypharmacy; D012307:Risk Factors