Deprescribing involves a systematic review of medications and identifying those medications with a high potential risk of harm and low benefit to the individual patient when incorporating the goals of care, safety, life expectancy, values, patient preferences, and level of functioning into the decision-making for discontinuing medications.1   According to Scott, et.al., an alternative definition of deprescribing includes: “Deprescribing is not about denying effective treatment to eligible patients. It is a positive, patient-centered intervention with inherent uncertainties, and requires shared decision-making, informed patient consent and close monitoring of effects.” 

Scott et.al. illustrated five steps of deprescribing that include: 

1. Reconcile all medications and the reason for each medication
2. Assess the overall potential harm from the medication regimen poses to the patient 
3. Evaluate each medication for its rationale to be deprescribed safely
4. Prioritize the sequence of medications for deprescribing
5. Implement the plan for deprescribing and monitor for tolerability by the patient1

Moreover, a more positive way to look at deprescribing is that it is a systemic, patient-centered way to optimize, minimize, and simplify an older person’s medication regimen.2 There is ample evidence that supports deprescribing can be beneficial when done appropriately. Garfinkel & Mangin (2010), completed a study with a mean age of 83 years and the deprescribing of an average of 5 routine medications (including but not limited to:  antihypertensives, PPI, diuretics, statin etc.) showed results of no attributed deaths due to deprescribing and an 88% improvement in Global Assessment Scale.3

In conclusion, when deprescribing is done systematically, with appropriate prioritization and adequate monitoring for tolerability by the individual, it can be safe and beneficial for elderly persons. 

2020 CALTCM Summit for Excellence attendees can view Dr. Hoffman's presentation, along with other annual meeting recordings, via the CALTCM Learning Portal.

References

1.     Scott, IA, Le Couteur, DJ. Physicians need to take the lead in deprescribing. Intern Med J(2015);45(3):352-56. 

2.     Haque R. ARMOR: a tool to evaluate polypharmacy in elderly persons. Ann Long-Term Care, 2009;17(6):26-30.