Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2016 Mar 4;11(3):e0149984.
doi: 10.1371/journal.pone.0149984. eCollection 2016.

Deprescribing in Frail Older People: A Randomised Controlled Trial

Kathleen Potter  1   2 , Leon Flicker  1   3   2 , Amy Page  1 , Christopher Etherton-Beer  1   3   2
Affiliations
Randomized Controlled Trial

Deprescribing in Frail Older People: A Randomised Controlled Trial

Kathleen Potter et al. PLoS One. .

Abstract

Objectives: Deprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed to reduce the number of medicines consumed by people living in residential aged care facilities (RACF). Secondary objectives were to explore the effect of deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality of life, and sleep.

Methods: Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were randomised in an open study. The intervention group (n = 47) received a deprescribing intervention, the planned cessation of non-beneficial medicines. The control group (n = 48) received usual care. Participants were monitored for twelve months from randomisation. Primary outcome was change in the mean number of unique regular medicines. All outcomes were assessed at baseline, six, and twelve months.

Results: Study participants had a mean age of 84.3 ± 6.9 years and 52% were female. Intervention group participants consumed 9.6 ± 5.0 and control group participants consumed 9.5 ± 3.6 unique regular medicines at baseline. Of the 348 medicines targeted for deprescribing (7.4 ± 3.8 per person, 78% of regular medicines), 207 medicines (4.4 ± 3.4 per person, 59% of targeted medicines) were successfully discontinued. The mean change in number of regular medicines at 12 months was -1.9 ± 4.1 in intervention group participants and +0.1 ± 3.5 in control group participants (estimated difference 2.0 ± 0.9, 95%CI 0.08, 3.8, p = 0.04). Twelve intervention participants and 19 control participants died within 12 months of randomisation (26% versus 40% mortality, p = 0.16, HR 0.60, 95%CI 0.30 to 1.22) There were no significant differences between groups in other secondary outcomes. The main limitations of this study were the open design and small participant numbers.

Conclusions: Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000370909.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors of this manuscript have the following competing interests: KP, CEB, and LF all hold grants from the NHMRC. CEB is a member of a government advisory board (the Pharmaceutical Benefits Advisory Committee - a statutory committee providing independent advice to the Minister under provisions of the National Health Act). KP, CEB, LF and AP have no other competing interests to declare. This does not alter the authors' adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Deprescribing Algorithm.
Fig 2
Fig 2. Recruitment and Participation.
Fig 3
Fig 3. Deprescribing Outcomes.
“Withdrawal Achieved” means medicine ceased or changed to PRN used less frequently than once per week at the last follow-up assessment point; RN, registered nurse; NOK, next of kin; GP, general practitioner. Percentages for “Withdrawal Failed” and “Withdrawal Achieved” are calculated as a percentage of the “Withdrawal Attempted” total. Italic numbers in () in the two large explanatory boxes refer to number of people.
Fig 4
Fig 4. Change in the mean number of regular medicines per person.
Closed bars are the intervention group. Open bars are the control group. Error bars are 1 SEM.
Fig 5
Fig 5. Kaplan Meier survival plot to 12 months post-randomisation.
See this image and copyright information in PMC

References

    1. Jörgensen T, Johansson S, Kennerfalk A, Wallander M-A, Svärdsudd K (2001) Prescription Drug Use, Diagnoses, and Healthcare Utilization among the Elderly. Annals of Pharmacotherapy 35: 1004–1009. - PubMed
    1. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivelä S-L, et al. (2002) Use of medications and polypharmacy are increasing among the elderly. Journal of Clinical Epidemiology 55: 809–817. - PubMed
    1. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, et al. (2012) A national census of medicines use: a 24-hour snapshot of Australians aged 50 years and older. Med J Aust 196: 50–53. - PubMed
    1. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Mitchell AA (2002) Recent patterns of medication use in the ambulatory adult population of the united states: The slone survey. JAMA 287: 337–344. - PubMed
    1. Qato DM, Alexander G, Conti RM, Johnson M, Schumm P, et al. (2008) USe of prescription and over-the-counter medications and dietary supplements among older adults in the united states. JAMA 300: 2867–2878. 10.1001/jama.2008.892 - DOI - PMC - PubMed

Publication types