3682 Outcomes of deprescribing for older people with life-limiting conditions: a systematic review

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Abstract Introduction Polypharmacy and potentially inappropriate prescribing are common in older people with life-limiting conditions. While deprescribing—a structured approach to reducing or discontinuing medications—is one approach to address this, its impact in this population is not well understood. Therefore, this systematic review aimed to synthesise evidence on outcomes of deprescribing medication in this population. Method A systematic search of MEDLINE, Embase, Scopus, PyscINFO and CINAHL was conducted to identify original studies reporting clinical-, medication-, and system-related outcomes of deprescribing. Studies published in English between January 2000 and December 2024 were included and analysed. Results: A total of 17,457 studies were screened, of which 46 met the eligibility criteria. Most of them were pre-post interventional (n = 14) and cohort studies (n = 14), conducted in nursing homes/long-term care facilities (n = 19) and hospitals (n = 14). Studies were mostly conducted in the North America (n = 20) and Europe (n = 14). Results A broad range of outcomes were reported in the literature, predominantly on clinical-related outcomes. Particularly, medication reduction, and mortality and survival outcomes were the most common. All studies assessing the impact on the number of medications used reported either a reduction in overall medication burden or inappropriate medications (n = 15), or no significant change (n = 3). Mortality and survival outcomes were reported in 16 studies: 4 each showed improved survival and reduced survival, and the remainder found no significant change. For other outcomes, the studies showed that deprescribing did not generally worsen the outcomes in the majority cases. Conclusion This systematic review suggests that deprescribing has several beneficial outcomes, including reducing medication burden and healthcare cost. While there is no strong evidence for harm, a small proportion of patients may face risks, so a careful monitoring is essential. ​Further studies should explore how outcome vary by disease conditions and medication types.

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