title: Recommendations to support deprescribing medications late in life.
abstract: It is widely acknowledged that patients-particularly those late in life-are frequently exposed to the harms of medication. To minimize these harms, several frameworks have been developed by which prescribing can be optimized. In the context of diminishing life expectancy, these frameworks can be used to reduce medications that are no longer necessary, but appear to fall short of actual guidelines that incorporate a consideration of stopping medications. In this commentary, we present recommendations that could be incorporated into prescribing processes for all healthcare professionals and, ultimately, used to support the rationalization or deprescribing of medication in diminished life expectancy. We frame these recommendations in the same context as guidance for the initiation and discontinuation of implantable cardiac devices and argue that the two processes-with regards to decision-making-should be the same. We present our recommendations with preventive medication use in mind, and use statin therapy as an illustrative example.
authors.affiliation: Division of Pharmacy, School of Medicine, Pharmacy and Health, Durham University, Queen's Campus, Stockton-on-Tees, UK. adam.todd@durham.ac.uk.
authors.forename: Adam
authors.initials: A
authors.lastname: Todd
authors.affiliation: Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA.
authors.forename: Holly M
authors.initials: HM
authors.lastname: Holmes
mesh_terms: D000367:Age Factors; D000069340:Deprescriptions; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D008017:Life Expectancy; D019338:Polypharmacy
keywords: Deprescribing; Polypharmacy; Rationalizing medications