Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.
NIHR Applied Research Collaboration Wessex, Southampton, UK.
BMC Geriatr. 2021 Apr 17;21(1):258. doi: 10.1186/s12877-021-02208-8.
Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important component of optimizing medication. This systematic review aims to summarise the current evidence for deprescribing among older people living with frailty.
The literature was searched using Medline, Embase, CINAHL, PsycInfo, Web of Science, and the Cochrane library up to May 2020. Interventional studies with any design or setting were included if they reported deprescribing interventions among people aged 65+ who live with frailty identified using reliable measures. The primary outcome was safety of deprescribing; whereas secondary outcomes included clinical outcomes, medication-related outcomes, feasibility, acceptability and cost-related outcomes. Narrative synthesis was used to summarise findings and study quality was assessed using Joanna Briggs Institute checklists.
Two thousand three hundred twenty-two articles were identified and six (two randomised controlled trials) were included with 657 participants in total (mean age range 79-87 years). Studies were heterogeneous in their designs, settings and outcomes. Deprescribing interventions were pharmacist-led (n = 3) or multidisciplinary team-led (n = 3). Frailty was identified using several measures and deprescribing was implemented using either explicit or implicit tools or both. Three studies reported safety outcomes and showed no significant changes in adverse events, hospitalisation or mortality rates. Three studies reported positive impact on clinical outcomes including depression, mental health status, function and frailty; with mixed findings on falls and cognition; and no significant impact on quality of life. All studies described medication-related outcomes and reported a reduction in potentially inappropriate medications and total number of medications per-patient. Feasibility of deprescribing was reported in four studies which showed that 72-91% of recommendations made were implemented. Two studies evaluated and reported the acceptability of their interventions and further two described cost saving.
There is a paucity of research about the impact of deprescribing in older people living with frailty. However, included studies suggest that deprescribing could be safe, feasible, well tolerated and can lead to important benefits. Research should now focus on understanding the impact of deprescribing on frailty status in high risk populations.
The review was registered on the international prospective register of systematic reviews (PROSPERO) ID number: CRD42019153367 .
患有衰弱症的老年人通常会同时服用多种药物，并且存在药物潜在危害的风险。针对这一人群的有针对性的药物减量治疗是优化药物治疗的重要组成部分。本系统综述旨在总结目前关于患有衰弱症的老年人药物减量治疗的证据。
检索了 Medline、Embase、CINAHL、PsycInfo、Web of Science 和 Cochrane 图书馆中的文献，检索时间截至 2020 年 5 月。纳入了任何设计或环境下的干预性研究，如果它们报告了在使用可靠措施确定的 65 岁以上患有衰弱症的人群中进行药物减量治疗的干预措施。主要结局是药物减量治疗的安全性；次要结局包括临床结局、药物相关结局、可行性、可接受性和成本相关结局。采用叙述性综述方法总结研究结果，并使用 Joanna Briggs 研究所清单评估研究质量。
共确定了 2322 篇文章，纳入了 6 项研究（2 项随机对照试验），共纳入 657 名参与者（平均年龄 79-87 岁）。研究在设计、环境和结局方面存在异质性。药物减量治疗由药剂师（n=3）或多学科团队（n=3）主导。使用了几种措施来确定衰弱程度，并且使用了明确或隐含的工具或两者结合来实施药物减量治疗。有 3 项研究报告了安全性结局，显示不良反应、住院或死亡率没有显著变化。有 3 项研究报告了对临床结局的积极影响，包括抑郁、心理健康状况、功能和衰弱；对跌倒和认知的影响则存在混合结果；对生活质量没有显著影响。所有研究都描述了药物相关结局，并报告了潜在不适当药物和每位患者的药物总数的减少。有 4 项研究报告了药物减量治疗的可行性，结果显示，提出的建议中有 72%-91%得到了实施。有 2 项研究评估并报告了他们的干预措施的可接受性，还有 2 项研究描述了成本节约。
关于患有衰弱症的老年人药物减量治疗的影响，研究还很匮乏。但是，纳入的研究表明，药物减量治疗可能是安全、可行、可耐受的，并能带来重要的益处。现在的研究应该集中在了解药物减量治疗对高危人群衰弱状况的影响上。
本综述已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号：CRD42019153367。
