Improving Care for Older Adults with Deprescribing Interventions

The use of multiple medications, known as polypharmacy, is a widespread concern among older adults receiving continuous healthcare. A clinical trial investigated a special type of care known as a patient-centered deprescribing intervention for older individuals moving from the hospital to post-acute care (PAC) facilities. This article aims to explain the trial's main discoveries, focusing on the importance of simplifying medication routines and ensuring safer healthcare transitions for older individuals.

Clinical trial

Between March 2016 and October 2020, researchers conducted a trial involving 372 older adults dealing with polypharmacy, aged 50 years or above, and using five or more medications before hospitalization. These individuals were split into two groups: one received the deprescribing intervention, and the other followed standard care procedures.

People who didn’t speak English or lived long-term in nursing homes were not part of the trial. The intervention group experienced a thorough medication review led by pharmacists or nurse practitioners, involving recommendations to reduce medications. This process started in the hospital and continued during their stay in the PAC facility. Meanwhile, the control group received usual care at both places.

Results

The results revealed significant advantages for the group that underwent the special deprescribing intervention. Those who received this unique care showed a noteworthy decrease in the number of medications they were taking compared to those who received standard care. At discharge from the PAC facility and throughout the 90-day follow-up period, individuals in the intervention group were using notably fewer medications, with reductions of 14% and 15%, respectively, compared to those in the control group. Moreover, the intervention led to a decrease in potentially inappropriate medications and the Drug Burden Index, without significantly changing the rates of adverse drug events.

Implications

This trial demonstrates the safety and effectiveness of personalized deprescribing interventions in lessening the overall medication burden for older adults transitioning between healthcare settings. Importantly, the sustained reduction in medication use even 90 days after leaving the PAC facility suggests potential long-term benefits of these interventions.

Conclusion

The findings from this trial highlight the positive influence of specialized deprescribing interventions in improving care for older adults managing multiple medications when moving from hospitalization to PAC facilities. The outcomes underscore the importance of tailoring medication strategies to reduce the load of medications while ensuring patient safety. Additional research is needed to explore how these interventions affect long-term health outcomes and the experiences reported by patients.

By placing a priority on personalized patient care and implementing targeted deprescribing strategies, healthcare providers can potentially enhance the well-being of older adults by simplifying medication routines and ensuring smoother transitions between healthcare settings.

__________