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Drugs & Aging

, Volume 36, Issue 12, pp 1097–1110 | Cite as

Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature

  • Jennifer A. PruskowskiEmail author
  • Sydney Springer
  • Carolyn T. Thorpe
  • Michele Klein-Fedyshin
  • Steven M. Handler
Systematic Review

Abstract

Background

Deprescribing has been shown to reduce potentially inappropriate or unnecessary medications; however, whether these benefits translate into improved quality of life (QOL) is uncertain.

Objective

The objective of this study was to isolate the impact of deprescribing on patient or designated representative reported QOL; satisfaction with care (SWC) and emergency department (ED) visits and hospitalizations were also investigated to further explore this question.

Methods

This systematic review searched the Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE, and EMBASE from database inception until November 2017. Randomized controlled trials and non-randomized prospective studies of older adults (> 65 years or older) and older persons with life-limiting conditions were included. Two reviewers independently assessed the search results and performed risk of bias assessments. Data on QOL, SWC, and ED visits and hospitalizations were extracted from all identified studies. Risk of bias of individual studies was assessed using measures recommended by the Cochrane Collaboration.

Results

Screening of 6543 eligible records identified 12 studies within 13 articles. In ten studies investigating the reduction of at least one medication deprescribed, compared with usual care, all but two found no difference in QOL. To date there has only been one study examining the impact of deprescribing on SWC, which was found to be not statistically significant. Four studies exploring the impact of deprescribing on ED visits and hospitalizations also found no significant difference. However, many studies were found to have a higher performance, detection, or other bias. We found considerable heterogeneity in patient populations, targeted medications for deprescribing, and QOL measurements used in these studies.

Conclusion

Based on a limited number of studies with varying methodological rigor, deprescribing may not significantly improve QOL or SWC; however, it may not contribute to additional ED visits and hospitalizations. Future controlled studies are needed.

Notes

Compliance with Ethical Standards

Conflict of interest

Jennifer A. Pruskowski, Carolyn T. Thorpe, Michele Klein-Fedyshin, and Steven M. Handler declare that they have no conflicts of interest. Sydney Springer’s work on this project was supported by the Department of Veterans Affairs, Office of Academic Affairs Fellowship in Medicare Safety & Pharmacy Outcomes. The views expressed are those of the authors and do not represent the views of the Department of Veterans Affairs.

Funding

The authors received no funding support for this work or to assist in the preparation of this article.

Supplementary material

40266_2019_717_MOESM1_ESM.docx (16 kb)
Supplementary material 1 (DOCX 16 kb)

References

  1. 1.
    Saraf AA, Petersen AW, Simmons SF, et al. Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities. J Hosp Med. 2016;11:694–700.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(862):e1–9.Google Scholar
  3. 3.
    Redston MR, Hilmer SN, McLachlan AJ, Clough AJ, Gnjidic D. Prevalence of potentially inappropriate medication use in older inpatients with and without cognitive impairment: a systematic review. J Alzheimers Dis. 2018;61:1639–52.PubMedGoogle Scholar
  4. 4.
    Harrison SL, O’Donnell LK, et al. Associations between the Drug Burden Index, potentially inappropriate medications and quality of life in residential aged care. Drugs Aging. 2018;35:83–91.PubMedGoogle Scholar
  5. 5.
    Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med. 2012;28:287–300.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Pérez-Jover V, Mira JJ, Carratala-Munuera C, et al. Inappropriate use of medication by elderly, polymedicated, or multipathological patients with chronic diseases. Int J Environ Res Public Health. 2018;15(2):E310.PubMedGoogle Scholar
  7. 7.
    Eckerblad J, Theander K, Ekdahl A, et al. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr. 2015;15:1.PubMedPubMedCentralGoogle Scholar
  8. 8.
    Deshields TL, Potter P, Olsen S, Liu J. The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year. Support Care Cancer. 2014;22:1089–96.PubMedGoogle Scholar
  9. 9.
    Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827–34.PubMedGoogle Scholar
  10. 10.
    Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging. 2018;35:303–19.PubMedGoogle Scholar
  11. 11.
    Pruskowski J, Handler SM. The DE-PHARM Project: a pharmacist-driven deprescribing initiative in a nursing facility. Consult Pharm. 2017;32:468–78.PubMedGoogle Scholar
  12. 12.
    Wouters H, Scheper J, Koning H, et al. Discontinuing inappropriate medication use in nursing home residents: a cluster randomized controlled trial. Ann Intern Med. 2017;167:609–17.PubMedGoogle Scholar
  13. 13.
    Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807.PubMedGoogle Scholar
  14. 14.
    Stevenson J, Abernethy AP, Miller C, Currow DC. Managing comorbidities in patients at the end of life. BMJ. 2004;329:909–12.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60:34–41.PubMedGoogle Scholar
  16. 16.
    Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82:583–623.PubMedPubMedCentralGoogle Scholar
  17. 17.
    Bandayrel K, Johnston BC. Recent advances in patient and proxy-reported quality of life research. Health Qual Life Outcomes. 2014;12:110.PubMedPubMedCentralGoogle Scholar
  18. 18.
    Bladh L, Ottosson E, Karlsson J, Klintberg L, Wallerstedt SM. Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial. BMJ Qual Saf. 2011;20:738–46.PubMedGoogle Scholar
  19. 19.
    Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.PubMedGoogle Scholar
  20. 20.
    Gillespie U, Alassaad A, Hammarlund-Udenaes M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization—analyses from a randomized controlled trial. PLoS One. 2013;8:e62401.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007;55:658–65.PubMedGoogle Scholar
  22. 22.
    Van der Linden L, Decoutere L, Walgraeve K, et al. Combined use of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review in very old inpatients: impact on quality of prescribing and clinical outcome. Drugs Aging. 2017;34:123–33.PubMedGoogle Scholar
  23. 23.
    Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Eden J, Levit L, Berg A, et al., editors. Finding what works in health care: standards for systematic reviews. Washington, DC: National Academies Press (US); 2011.  https://doi.org/10.17226/13059. https://www.ncbi.nlm.nih.gov/books/NBK209518/. Accessed 23 Sept 2019.Google Scholar
  24. 24.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94.PubMedGoogle Scholar
  25. 25.
    Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Beer C, Loh PK, Peng YG, Potter K, Millar A. A pilot randomized controlled trial of deprescribing. Ther Adv Drug Saf. 2011;2:37–43.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Bergh S, Selbæk G, Engedal K. Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ. 2012;344:e1566.PubMedGoogle Scholar
  29. 29.
    Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. Eur J Clin Pharmacol. 2014;70(10):1251–60.PubMedGoogle Scholar
  30. 30.
    Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175:691–700.PubMedPubMedCentralGoogle Scholar
  31. 31.
    Lopez-Peig C, Mundet X, Casabella B, del Val JL, Lacasta D, Diogene E. Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain. BMC Res Notes. 2012;5:684.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Moonen JE, Foster-Dingley JC, de Ruijter W, et al. Effect of discontinuation of antihypertensive treatment in elderly people on cognitive functioning—the DANTE Study Leiden: a randomized clinical trial. JAMA Intern Med. 2015;175:1622–30.PubMedGoogle Scholar
  33. 33.
    Polinder S, Boyé ND, Mattace-Raso FU, et al. Cost-utility of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial. BMC Geriatr. 2016;16:179.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLoS One. 2016;11:e0149984.PubMedPubMedCentralGoogle Scholar
  35. 35.
    Sakakibara M, Igarashi A, Takase Y, Kamei H, Nabeshima T. Effects of prescription drug reduction on quality of life in community-dwelling patients with dementia. J Pharm Pharm Sci. 2015;18:705–12.PubMedGoogle Scholar
  36. 36.
    Ulfvarson J, Adami J, Wredling R, Kjellman B, Reilly M, von Bahr C. Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression. Eur J Clin Pharmacol. 2003;59:735–40.PubMedGoogle Scholar
  37. 37.
    Boyé ND, van der Velde N, de Vries OJ, et al. Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial. Age Ageing. 2017;46:142–6.PubMedGoogle Scholar
  38. 38.
    Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9:430–4.PubMedGoogle Scholar
  39. 39.
    Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: beta-blocker CONtinuation vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30:2186–92.PubMedGoogle Scholar
  40. 40.
    Cantril H. The pattern of human concerns. New Brunswick: Rutgers University Press; 1965.Google Scholar
  41. 41.
    Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.PubMedGoogle Scholar
  42. 42.
    Cohen SR, Mount BM, Strobel MG, Bui F. The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995;9:207–19.PubMedGoogle Scholar
  43. 43.
    Torisson G, Stavenow L, Minthon L, Londos E. Reliability, validity and clinical correlates of the Quality of Life in Alzheimer’s disease (QoL-AD) scale in medical inpatients. Health Qual Life Outcomes. 2016;14:90.PubMedPubMedCentralGoogle Scholar
  44. 44.
    Hagell P, Westergren A, Årestedt K. Beware of the origin of numbers: standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations. Res Nurs Health. 2017;40:378–86.PubMedGoogle Scholar
  45. 45.
    Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: scoping review. SAGE Open Med. 2016;4:2050312116671725.  https://doi.org/10.1177/2050312116671725.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Dills H, Shah K, Messinger-Rapport B, Bradford K, Syed Q. Deprescribing medications for chronic diseases management in primary care settings: a systematic review of randomized controlled trials. J Am Med Dir Assoc. 2018;19(923–935):e2.Google Scholar
  47. 47.
    Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in the elderly. Expert Opin Drug Saf. 2014;13(1):57–65.PubMedGoogle Scholar
  48. 48.
    Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Lee M, Saver JL, Wu YL, et al. Utilization of statins beyond the initial period after stroke and 1-year risk of recurrent stroke. J Am Heart Assoc. 2017;6:e005658.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes towards deprescribing in older Medicare beneficiaries in the United States. JAMA Intern Med. 2018;178:1673–80.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Kuntz J, Kouch L, Christian D, Peterson PL, Gruss I. Barriers and facilitators to the deprescribing of nonbenzodiazepine sedative medications among older adults. Perm J. 2018;22:17–157.PubMedPubMedCentralGoogle Scholar
  52. 52.
    Dou C, Rebane J, Bardal S. Intervention to improve benzodiazepine tapering success in the elderly: a systematic review. Aging Ment Health. 2018;16:1–6.Google Scholar
  53. 53.
    Payakachat N, Ali MM, Tilford JM. Can the EQ-5D detect meaningful change? A systematic review. Pharmacoeconomics. 2015;33:1137–54.PubMedPubMedCentralGoogle Scholar
  54. 54.
    Glasziou P, Alexander J, Beller E, Clarke P. Which health-related quality of life score? A comparison of alternative utility measures in patients with type 2 diabetes in the ADVANCE trial. Health Qual Life Outcomes. 2007;5:21.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Tseng HM, Lee CH, Chen YJ, Hsu HH, Huang LY, Huang JL. Developing a measure of medication-related quality of life for people with polypharmacy. Qual Life Res. 2016;25:1295–302.PubMedGoogle Scholar
  56. 56.
    Thompson W, Reeve E, Moriarty F, et al. Deprescribing: future directions for research. Res Social Adm Pharm. 2019;15:801–5.PubMedGoogle Scholar
  57. 57.
    Mohammed MA, Moles RJ, Chen TF. Pharmaceutical care and health related quality of life outcomes over the past 25 years: have we measured dimensions that really matter? Int J Clin Pharm. 2018;40:3–14.PubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.School of PharmacyUniversity of PittsburghPittsburghUSA
  2. 2.Veterans Affairs Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.College of PharmacyUniversity of New EnglandPortlandUSA
  4. 4.Eshelman School of PharmacyUniversity of North CarolinaChapel HillUSA
  5. 5.Library SystemUniversity of Pittsburgh Health SciencesPittsburghUSA
  6. 6.School of MedicineUniversity of PittsburghPittsburghUSA

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