title: The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis.
abstract: Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effective and feasible intervention to modify mortality and health outcomes in older adults.
  
  
  
  Specified databases were searched from inception to February 2015. Two researchers independently screened all retrieved articles for inclusion, assessed study quality and extracted data. Data were pooled using RevMan v5.3. Eligible studies included those where older adults had at least one medication deprescribed. The primary outcome was mortality. Secondary outcomes were adverse drug withdrawal events, psychological and physical health outcomes, quality of life, and medication usage (e.g. successful deprescribing, number of medications prescribed, potentially inappropriate medication use).
  
  
  
  A total of 132 papers met the inclusion criteria, which included 34 143 participants aged 73.8 ± 5.4 years. In nonrandomized studies, deprescribing polypharmacy was shown to significantly decrease mortality (OR 0.32, 95% CI: 0.17-0.60). However, this was not statistically significant in the randomized studies (OR 0.82, 95% CI 0.61-1.11). Subgroup analysis revealed patient-specific interventions to deprescribe demonstrated a significant reduction in mortality (OR 0.62, 95% CI 0.43-0.88). However, generalized educational programmes did not change mortality (OR 1.21, 95% CI 0.86-1.69).
  
  
  
  Although nonrandomized data suggested that deprescribing reduces mortality, deprescribing was not shown to alter mortality in randomized studies. Mortality was significantly reduced when applying patient-specific interventions to deprescribe in randomized studies.
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.
authors.forename: Amy T
authors.identifier: 0000-0002-2084-8469
authors.initials: AT
authors.lastname: Page
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.
authors.forename: Rhonda M
authors.initials: RM
authors.lastname: Clifford
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Potter
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.|Graylands Hospital, Mt Claremont, Western Australia, Australia.
authors.forename: Darren
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: School of Medicine and Pharmacology, University of Western Australia, 35 Stirling Highway, Crawley, 6009, Western Australia, Australia.|Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: Christopher D
authors.identifier: 0000-0001-5148-0188
authors.initials: CD
authors.lastname: Etherton-Beer
mesh_terms: D000069340:Deprescriptions; D006801:Humans; D057970:Inappropriate Prescribing / Q000009:adverse effects* / Q000401:mortality*; D019338:Polypharmacy
keywords: deprescribing; medication discontinuation; meta-analysis; older adults; polypharmacy; systematic review