6ER-036 Deprescribing tools for the elderly: a systematic review

Abstract

Background and importance Deprescription is the revision of the therapeutic plan with the aim of simplifying it, taking into account the preferences of the patient, prognosis and the environment. This strategy acquires special relevance in elderly patients as they are exposed to numerous adverse effects and interactions. Aim and objectives To identify the deprescribing tools (DT) aimed at elderly patients available in the scientific literature and their main characteristics. Material and methods A systematic search was conducted in PubMed and EMBASE for relevant literature published up to April 2020, applying the PRISMA method. The search strategy included terms for deprescribing, study population (aged OR elderly) and deprescribing strategies (tool OR process OR criteria OR algorithm). Inclusion criteria were: observational/experimental studies which created or developed a DT in elderly patients. Exclusion criteria were: studies where the DT was aimed at a specific medication, pharmacological group or pathology. Tools identified were analysed according to whether they were criterion/algorithm type. Results 13/485 papers met the inclusion criteria, and 11 tools were identified: 5 ‘algorithm based tools’ and 6 ‘criterion based tools’ (2 of the articles developed the validation of 2 criterion based tools). All tools were aimed at elderly patients, with peculiarities regarding their design, population, setting of application and items that formed the tool. Algorithm based tools The methodology used for its development was not specified. Population: two of them focused specifically on patients with limited life expectancy. Settings of application: two algorithms were applied to institutionalised patients, one to hospitalised patients and the remaining two did not specify the scenario. Criterion based tools Five used the Delphi method for their design and development. Population: one was focused on patients with multimorbidity or similar characteristics and two were aimed at patients with limited life expectancy. Settings of application: three tools were aimed at institutionalised patients, two other tools were aimed at all healthcare settings and the other one to outpatients. It is important to emphasise that most of the tools agreed on the pharmacological groups that were likely to be deprescribed (statins, antipsychotics, proton pump inhibitors and antidepressants). Conclusion and relevance Knowing and being able to use DT aimed at hospitalised or multimorbidity patients could be very useful for hospital pharmacists, allowing them to carry out this activity as part of their healthcare activity. References and/or acknowledgements Conflict of interest No conflict of interest