Deprescribing in Frail Older People: A Randomised Controlled Trial

PLoS One. 2016 Mar 4;11(3):e0149984. doi: 10.1371/journal.pone.0149984. eCollection 2016.

Abstract

Objectives: Deprescribing has been proposed as a way to reduce polypharmacy in frail older people. We aimed to reduce the number of medicines consumed by people living in residential aged care facilities (RACF). Secondary objectives were to explore the effect of deprescribing on survival, falls, fractures, hospital admissions, cognitive, physical, and bowel function, quality of life, and sleep.

Methods: Ninety-five people aged over 65 years living in four RACF in rural mid-west Western Australia were randomised in an open study. The intervention group (n = 47) received a deprescribing intervention, the planned cessation of non-beneficial medicines. The control group (n = 48) received usual care. Participants were monitored for twelve months from randomisation. Primary outcome was change in the mean number of unique regular medicines. All outcomes were assessed at baseline, six, and twelve months.

Results: Study participants had a mean age of 84.3 ± 6.9 years and 52% were female. Intervention group participants consumed 9.6 ± 5.0 and control group participants consumed 9.5 ± 3.6 unique regular medicines at baseline. Of the 348 medicines targeted for deprescribing (7.4 ± 3.8 per person, 78% of regular medicines), 207 medicines (4.4 ± 3.4 per person, 59% of targeted medicines) were successfully discontinued. The mean change in number of regular medicines at 12 months was -1.9 ± 4.1 in intervention group participants and +0.1 ± 3.5 in control group participants (estimated difference 2.0 ± 0.9, 95%CI 0.08, 3.8, p = 0.04). Twelve intervention participants and 19 control participants died within 12 months of randomisation (26% versus 40% mortality, p = 0.16, HR 0.60, 95%CI 0.30 to 1.22) There were no significant differences between groups in other secondary outcomes. The main limitations of this study were the open design and small participant numbers.

Conclusions: Deprescribing reduced the number of regular medicines consumed by frail older people living in residential care with no significant adverse effects on survival or other clinical outcomes.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12611000370909.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Algorithms
  • Drug Prescriptions / statistics & numerical data*
  • Female
  • Frail Elderly*
  • Humans
  • Kaplan-Meier Estimate
  • Male
  • Mortality
  • Patient Admission
  • Polypharmacy*
  • Quality of Life
  • Sleep
  • Surveys and Questionnaires
  • Western Australia

Associated data

  • ANZCTR/ACTRN12611000370909

Grants and funding

This study was funded by the National Health and Medical Research Council of Australia (http://www.nhmrc.gov.au) through a post-doctoral training fellowship for KP (APP1016241). Additional funding was provided by the Royal Australian College of General Practitioners (http://www.racgp.org.au), The Mason Foundation (http://www.eqt.com.au/not-for-profit-organisations/confirmed-2015-programs/eqt-medical-programs.aspx), and the Dementia Collaborative Research Centre (www.dementiaresearch.org.au). The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.