Drug cessation in complex older adults: time for action.
BACKGROUND
general opinion is growing that drug cessation in complex older patients is warranted in certain situations. From a clinical viewpoint, drug cessation seems most warranted in four situations, i.e., falls, delirium, cognitive impairment and end-of-life situations. To date, little information about the effects of drug cessation in these four situations is available.


OBJECTIVE
to identify the effects and effectiveness of drug cessation on falls, delirium and cognitive impairment. For end-of-life situations, we reviewed cessation of inappropriate drug use.


METHODS
electronic databases were searched using MeSH terms and relevant keywords. Studies published in English were included if they evaluated the effects of drug cessation in older persons, aged ≥65 years, with falls, delirium or cognitive impairment; or cessation of inappropriate drug use in end-of-life situations.


RESULTS
we selected seven articles for falls, none for delirium, two for cognition and two for end-of-life situations. Withdrawal of psychotropics reduced fall rate; a prescribing modification programme for primary care physicians reduced fall risk. Withdrawal of psychotropics and a systematic reduction of polypharmacy resulted in an improvement of cognition. Very little rigorous research has been conducted on reducing inappropriate medications in patients approaching end of life.


CONCLUSIONS
little research has focussed on drug cessation. Available studies showed a beneficial impact of cessation of psychotropic drugs on falls and cognitive status. More research in this field is needed. The issue of systematic drug withdrawal in end-of-life cases is controversial, but is increasingly relevant in the face of rising numbers of older people of this clinical status.
Internal Medicine - Section of Geriatric Medicine, Erasmus University Medical Center, Rotterdam, Netherlands.
Tischa J M
TJ
van der Cammen
Chakravarthi
C
Rajkumar
Graziano
G
Onder
Carolyn S
CS
Sterke
Mirko
M
Petrovic
D000058:Accidental Falls / Q000517:prevention & control*; D000367:Age Factors; D000368:Aged; D000375:Aging / Q000523:psychology; D003071:Cognition / Q000187:drug effects; D003072:Cognition Disorders / Q000139:chemically induced / Q000517:prevention & control* / Q000523:psychology; D003693:Delirium / Q000139:chemically induced / Q000517:prevention & control*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D011619:Psychotropic Drugs / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013727:Terminal Care; D028761:Withholding Treatment
D011619:Psychotropic Drugs
cognitive impairment; delirium; drug cessation; end of life; falls; older adults; older people