Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature
Deprescribing has been shown to reduce potentially inappropriate or unnecessary medications; however, whether these benefits translate into improved quality of life (QOL) is uncertain.
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.
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.
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.
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.
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.
The authors received no funding support for this work or to assist in the preparation of this article.
- 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
- 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
- 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.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
- 40.Cantril H. The pattern of human concerns. New Brunswick: Rutgers University Press; 1965.Google Scholar
- 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
- 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