Deprescribing medications in older people: a narrative review

摘要

In the aging population, the process of medication prescribing and management is likely to be complex and challenging. Polypharmacy and inappropriate medication use are more prevalent among older people and are associated with geriatric syndromes, reduced cognitive and functional outcomes, and increased mortality. Deprescribing is the process of planned and supervised tapering or safe withdrawal of potentially inappropriate medication that can cause harm, or is no longer indicated or beneficial to the current therapy. The purpose of deprescribing is to reduce inappropriate polypharmacy, medication burden and harm, and to improve patient health-related outcomes. Deprescribing is best performed by reducing medicines one at a time, and the whole process requires careful assessment, effort, commitment and time. Deprescribing should be considered after careful assessment of the patient's overall health, therapeutic goals, medication adherence to current treatment regimen and willingness to deprescribe the medicine. Many medications can be safely removed; to successfully achieve this, the process of deprescribing should follow an evidence-based, patient-centered and team-based approach involving both the healthcare professionals and the patient/caregivers to effectively reduce inappropriate medication use.