Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy

A Systematic Review

Publikation: Bidrag til tidsskriftReviewForskningpeer review

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Resumé

OBJECTIVES: To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN: Systematic review and narrative synthesis. SETTING: We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS: Frail older persons and older persons with limited life expectancy. MEASUREMENTS: Narrative description of tools. RESULTS: We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication-specific advice. The complexity of the tools ranged from simple lists to detailed, step-wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low-quality studies). CONCLUSION: Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019.

OriginalsprogEngelsk
TidsskriftJournal of the American Geriatrics Society
Vol/bind67
Udgave nummer1
Sider (fra-til)172-180
ISSN0002-8614
DOI
StatusUdgivet - 1. jan. 2019

Fingeraftryk

Life Expectancy
Literature
Expert Testimony
MEDLINE
Deprescriptions

Citer dette

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title = "Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy: A Systematic Review",
abstract = "OBJECTIVES: To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN: Systematic review and narrative synthesis. SETTING: We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS: Frail older persons and older persons with limited life expectancy. MEASUREMENTS: Narrative description of tools. RESULTS: We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication-specific advice. The complexity of the tools ranged from simple lists to detailed, step-wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low-quality studies). CONCLUSION: Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019.",
keywords = "deprescribing, end of life, frail",
author = "Wade Thompson and Carina Lundby and Trine Graabaek and Nielsen, {Dorthe S} and Jesper Ryg and Jens S{\o}ndergaard and Anton Potteg{\aa}rd",
note = "{\circledC} 2018, Copyright the Authors Journal compilation {\circledC} 2018, The American Geriatrics Society.",
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TY - JOUR

T1 - Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy

T2 - A Systematic Review

AU - Thompson, Wade

AU - Lundby, Carina

AU - Graabaek, Trine

AU - Nielsen, Dorthe S

AU - Ryg, Jesper

AU - Søndergaard, Jens

AU - Pottegård, Anton

N1 - © 2018, Copyright the Authors Journal compilation © 2018, The American Geriatrics Society.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - OBJECTIVES: To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN: Systematic review and narrative synthesis. SETTING: We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS: Frail older persons and older persons with limited life expectancy. MEASUREMENTS: Narrative description of tools. RESULTS: We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication-specific advice. The complexity of the tools ranged from simple lists to detailed, step-wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low-quality studies). CONCLUSION: Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019.

AB - OBJECTIVES: To summarize available tools that can assist clinicians in identifying and reducing or stopping (deprescribing) potentially inappropriate medications and that specifically consider frailty or limited life expectancy. DESIGN: Systematic review and narrative synthesis. SETTING: We searched MEDLINE (via Ovid SP), EMBASE (via Ovid SP), and CINAHL from inception to December 2017, along with grey literature. We included articles that described a tool to guide deprescribing of medications. PARTICIPANTS: Frail older persons and older persons with limited life expectancy. MEASUREMENTS: Narrative description of tools. RESULTS: We identified 15 tools and organized them into three main categories: tools (n = 2) that described a model or framework for approaching deprescribing, tools (n = 9) that outlined a deprescribing approach for the entire medication list, and tools (n = 4) that provided medication-specific advice. The complexity of the tools ranged from simple lists to detailed, step-wise protocols. The development methodology varied widely, and the methods used to synthesize the tools were generally not well described. Most tools were based on expert opinion. Only four of the 15 tools have been tested in clinical practice (in very low-quality studies). CONCLUSION: Tools exist to help clinicians deprescribe in frail older persons and those with limited life expectancy. These tools may assist clinicians at various stages in the deprescribing process. However, it remains to be investigated whether use of such tools in practice is likely to improve clinical outcomes or reduce inappropriate medication use. J Am Geriatr Soc 67:172–180, 2019.

KW - deprescribing

KW - end of life

KW - frail

U2 - 10.1111/jgs.15616

DO - 10.1111/jgs.15616

M3 - Review

VL - 67

SP - 172

EP - 180

JO - Journal of the American Geriatrics Society

JF - Journal of the American Geriatrics Society

SN - 0002-8614

IS - 1

ER -