An analysis of previously published studies has found that de-prescribing preventive medications among old, frail adults did not increase the risk of death, hospitalisation, or major heart-related events.
Findings published in the journal BioMed Central (BMC) Geriatrics also suggest that de-prescribing was not related with an increased risk of falls — a leading cause of disability among older adults — fractures or a reduced quality of life.
Researchers, including those from the Indian Council of Medical Research-National Institute for Research in Bacterial Infections, Kolkata, and Sweden`s Karolinska Institutet, added however that evidence certainty — a measure of confidence that the true effect of de-prescribing is close to one estimated from research — was low and more studies are required.
Frail, older adults having a limited life expectancy are commonly prescribed long-term preventive medications and concurrent multiple medications — “polypharmacy” — despite uncertain benefits and potential risks, the team said.
They analysed 15 studies, involving more than 33,000 participants and taken from databases including the `PubMed` and `Web of Science`.
The analysis produced evidence on the effect of de-prescribing preventive medications, such as antihypertensives, statins and antidiabetics, compared to
continuing clinical, physiological, safety, and patient-centred outcomes among older adults with advanced frailty, dementia, or limited life expectancy.
“De-prescribing preventive medications in frail or palliative older adults was not associated with worse outcomes; however, evidence certainty was very low, and further studies are needed,” the authors wrote.
“From 10,397 records, 15 studies were included. Overall, de-prescribing was not associated with increased risk of all-cause mortality, hospitalisation, or
MACE (major adverse cardiovascular event) (certainty: very low GRADE),” they said.
“De-prescribing was also not associated with increased risks of fracture, fall, or deterioration of quality of life, but with slightly increased systolic blood pressure (deprescribing antihypertensives),” they said.