Rahman Taibia, Bhatt Kunal, Patel Vaibhavi, Satishkumar Shrinika, Aptsiauri Bachana, Khairallah Terezia, Ridha Fathima
David Tvildiani Medical University, Tbilisi, Georgia.
Tbilisi State Medical University, Georgia.
Sage Open Aging. 2025 Jun 9;11:30495334251345091. doi: 10.1177/30495334251345091. eCollection 2025 Jan-Dec.
Polypharmacy is the concurrent use of many drugs increasingly prevalent in elderly populations worldwide, with over 50% of older adults taking more than five drugs. The rise in chronic conditions such as diabetes, hypertension, and dementia largely drives this trend. However, polypharmacy poses significant risks, including adverse drug events, falls, cognitive decline, and hospitalizations, particularly due to age-related physiological changes that alter drug metabolism and clearance. Vulnerable populations, especially those with comorbidities, face heightened risks of complications associated with polypharmacy, underscoring the need for effective management strategies. Despite extensive literature on polypharmacy, gaps remain in practical, evidence-based approaches to safely reduce medication burdens. Structured deprescribing protocols are emerging as a critical intervention for reducing inappropriate medication use, improving patient outcomes, and lowering healthcare costs. These protocols involve stepwise algorithms and tools for screening to find potentially inappropriate medications and clinical decision-making frameworks to prioritize deprescribing as it can reduce fall risk, hospitalizations, and healthcare costs while enhancing quality of life. This narrative review examines evidence from trials, cohort studies, and meta-analyses on deprescribing protocols, highlighting challenges like patient resistance and withdrawal effects. It emphasizes tailored approaches, patient engagement, and shared decision-making for safe, effective, patient-centered deprescribing across healthcare settings.
多重用药是指同时使用多种药物，这在全球老年人群中越来越普遍，超过50%的老年人服用五种以上药物。糖尿病、高血压和痴呆症等慢性病的增加在很大程度上推动了这一趋势。然而，多重用药带来了重大风险，包括药物不良事件、跌倒、认知能力下降和住院，特别是由于与年龄相关的生理变化会改变药物代谢和清除。弱势群体，尤其是那些患有合并症的人，面临着与多重用药相关的并发症风险增加，这凸显了有效管理策略的必要性。尽管有大量关于多重用药的文献，但在安全减轻用药负担的实用、循证方法方面仍存在差距。结构化的减药方案正在成为一种关键干预措施，用于减少不适当的药物使用、改善患者结局并降低医疗成本。这些方案涉及逐步算法和筛查工具，以发现潜在不适当的药物，以及临床决策框架，以便将减药列为优先事项，因为它可以降低跌倒风险、住院率和医疗成本，同时提高生活质量。这篇叙述性综述考察了关于减药方案的试验、队列研究和荟萃分析的证据，强调了患者抵触和戒断效应等挑战。它强调了在各种医疗环境中采用量身定制的方法、患者参与和共同决策，以实现安全、有效、以患者为中心的减药。
