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Deprescribing in frail older people: a randomised controlled trial

Dr Kathleen Potter, Prof Leon Flicker
Research Centre DCRC Assessment and Better Care
Partner Institution WA Centre for Health and Aging
Project Description

Our primary aim is to determine whether we can safely reduce the total number of medications prescribed to frail older people living in residential aged care facilities (RACF).

Secondary aims are to estimate the effect of deprescribing on survival, falls and fractures, sleep quality, cognitive function, and independence.

Our primary hypothesis is that it is feasible and safe to reduce the total number of medications prescribed to frail older people living in residential care.

Secondary hypotheses are that reducing total medication burden will improve quality of life by reducing the risk of falls and fractures and improving cognitive function, sleep quality, and independence levels.

Latest News:

We recently completed an open randomized controlled deprescribing study in 95 people living in four residential aged-care facilities in rural Western Australia. The average age of our participants was 84 years and they took 10 regular medicines on average. Approximately 75% of the people in the study had moderate or significant cognitive impairment.  

We ceased 207 medicines in 45 people (between four and five regular medicines per person) over the 12-month study period. Two people experienced a significant adverse drug withdrawal reaction during the study, but most medicines were withdrawn without causing any negative effects.   

The most common medicines ceased were long-term preventative medicines, specifically aspirin, cholesterol-lowering medicines, antihypertensive medicines, and vitamin and mineral supplements such as calcium and Vitamin D. Symptom-modifying medicines (laxatives, pain-killers, anti-depressants and medicines for anxiety and sleep problems) were more difficult to stop and we were not able to deprescribe many of these medicines.

We found deprescribing did not affect quality of life, sleep quality, cognitive or physical function, bowel function, falls risk, or hospital admissions. Nor did it appear to affect participant survival at 12 months. Twenty-six per cent of the deprescribing group participants died during the year compared with 40% of control group participants. Our study was small and although we were able to demonstrate the feasibility of deprescribing, larger trials will be needed to accurately estimate the benefits and harms of deprescribing in older people.

 

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