Kolling Institute of Medical Research, Sydney Medical School, Sydney University and Royal North Shore Hospital, St Leonards, New South Wales, Australia.
Faculty of Pharmacy and Charles Perkins Centre, University of Sydney, New South Wales, Australia.
Age Ageing. 2018 Sep 1;47(5):638-640. doi: 10.1093/ageing/afy014.
The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in the individual patient has been given a variety of names including the colloquial 'geriatrician's salute', 'de-intensification' and increasingly 'deprescribing'. The rise of deprescribing as a word with a definition, evidence base and implementation plan, reflects the changing environment in which we practice. In particular, the emphasis on evidence-based medicine and the need to care for our expanding ageing populations, which requires application of components of geriatric evaluation and management by a wider range of health care practitioners. However, there are still significant challenges related to research on the safety, efficacy and implementation of deprescribing. In this commentary, we discuss the current evidence on the effects of deprescribing, emergence of implementation tools to embed deprescribing into the clinical care of older adults, as well as efforts to develop guidelines to improve health care practitioners' awareness and self-efficacy of deprescribing. Ultimately, judicious prescribing and deprescribing, across a wide range of health care settings, ought to enable older people to use medicines to support their achievable ageing goals.
专业医疗保健人员为患者停止使用当前风险大于获益的药物，这一过程有多种名称，包括通俗的“老年医学家的敬礼”“减量化”和越来越多的“药物精简”。“药物精简”作为一个有定义、有证据基础和实施计划的词的出现，反映了我们实践环境的变化。特别是，强调循证医学以及需要照顾我们不断扩大的老龄化人口，这需要更广泛的医疗保健从业者应用老年评估和管理的各个组成部分。然而，在药物精简的安全性、疗效和实施方面的研究仍然存在重大挑战。在这篇评论中，我们讨论了关于药物精简效果的现有证据，出现了将药物精简纳入老年人临床护理的实施工具，以及努力制定指南以提高医疗保健从业者对药物精简的认识和自我效能感。最终，在广泛的医疗保健环境中，明智的处方和药物精简都应该能够使老年人使用药物来支持他们可实现的老龄化目标。
