title: Deprescribing in Frail Older People: A Randomised Controlled Trial.
abstract: OBJECTIVE
  Deprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed to reduce the number of medicines consumed by people living in residential aged care facilities (RACF). Secondary objectives were to explore the effect of deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality of life, and sleep.
  
  
  METHODS
  Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were randomised in an open study. The intervention group (n = 47) received a deprescribing intervention, the planned cessation of non-beneficial medicines. The control group (n = 48) received usual care. Participants were monitored for twelve months from randomisation. Primary outcome was change in the mean number of unique regular medicines. All outcomes were assessed at baseline, six, and twelve months.
  
  
  RESULTS
  Study participants had a mean age of 84.3 ± 6.9 years and 52% were female. Intervention group participants consumed 9.6 ± 5.0 and control group participants consumed 9.5 ± 3.6 unique regular medicines at baseline. Of the 348 medicines targeted for deprescribing (7.4 ± 3.8 per person, 78% of regular medicines), 207 medicines (4.4 ± 3.4 per person, 59% of targeted medicines) were successfully discontinued. The mean change in number of regular medicines at 12 months was -1.9 ± 4.1 in intervention group participants and +0.1 ± 3.5 in control group participants (estimated difference 2.0 ± 0.9, 95%CI 0.08, 3.8, p = 0.04). Twelve intervention participants and 19 control participants died within 12 months of randomisation (26% versus 40% mortality, p = 0.16, HR 0.60, 95%CI 0.30 to 1.22) There were no significant differences between groups in other secondary outcomes. The main limitations of this study were the open design and small participant numbers.
  
  
  CONCLUSIONS
  Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12611000370909.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Potter
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Leon
authors.initials: L
authors.lastname: Flicker
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Page
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.|Department of Geriatric Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.|Western Australian Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Etherton-Beer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D016330:Frail Elderly; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009026:Mortality; D010343:Patient Admission; D019338:Polypharmacy; D011788:Quality of Life; D012890:Sleep; D011795:Surveys and Questionnaires; D014904:Western Australia