Deprescribing: A new paradigm in the treatment of older patients

Abstract

Population aging and the increasing prevalence of chronic diseases have led to an increase in polypharmacy among older patients. Although polypharmacy often represents rational pharmacotherapy, it is associated with an increased risk of adverse drug reactions, drug-drug interactions, reduced medication adherence, and hospitalizations. Considering these challenges, deprescribing has emerged in recent years as an important strategy for optimizing pharmacotherapy. Deprescribing is a systematic process of identifying and discontinuing medications for which the potential risks outweigh the expected benefits, while taking into account treatment goals, life expectancy, functional status, and patient preferences. This presentation will outline contemporary principles of deprescribing and highlight the role of pharmacists in this process. The deprescribing process includes regular medication reviews, assessment of indications for each medication, identification of potentially inappropriate medications, evaluation of the risks associated with treatment discontinuation, and ongoing patient monitoring. Validated tools used to identify candidates for deprescribing include the Beers Criteria, STOPP/START criteria, and various anticholinergic burden scales. Studies have demonstrated that deprescribing interventions can be successful for medications such as benzodiazepines, nonsteroidal anti-inflammatory drugs, proton pump inhibitors, and others. Although practical barriers, including limited time and inadequate reimbursement, may hinder implementation, evidence suggests that pharmacist involvement in deprescribing initiatives leads to improved clinical and economic outcomes. Deprescribing represents a new paradigm in the care of older adults, focused on individualized, safe, and rational pharmacotherapy. Its successful implementation requires a multidisciplinary approach, with pharmacists playing a key role in improving the quality of healthcare for older adults.