Author: Pharm Joseph Y. B. Bennie

It is universally accepted that as an individual grows in age, one’s health gradually declines.  Yet, one of the wishes extended to birthday celebrants is long life filled with good health. People desire that even in old age, the quality of life and well-being should not be unjustifiably jeopardized.

The multiple diseases, and at times deteriorating health conditions in old age, come with the application of advanced and modern treatment.  In the process, polypharmacy becomes the obvious choice with its attendant challenges.

At the 83rd International Federation of Pharmacists (FIP) World Congress of Pharmacy and Pharmaceutical Sciences in Denmark, September 2025, Congress discussed Deprescribing: Facts and controversies of promoting sustainable practices and personalised care in an ageing population.  Prof. Mangin, Dr. Perello and Prof. Pottegård made presentations.

Prof. Dee Mangin spoke about Aligning treatment with life expectancy, patient preferences, and quality of life. She indicated that the desire of many, in old age, is to age gracefully.  Ageing well is a concept with varying meaning to different people. For some, it might be to avoid premature death.  This stage of life is also characterised by the presence of multiple diseases.  The desire of most patients then, is that the clinical decisions, taken with their inputs, will not just be to prolong their life but enhance the quality of their life during and after the treatment.

Prof. Mangin also explained that although the use of multiple medications to manage multiple disease conditions can improve the quality of life, it can have a negative impact on the quality of life through the impact of polypharmacy.  Addressing the underlying issues of polypharmacy, through deprescribing, can improve the quality of life of older patients.  Emphasising this point, Frank and Weir (2014) explained that to improve the quality of life and well-being in older patients, it is desired that optimal prescribing should be paramount.  It calls for deprescribing medications that no longer align with the current goal of the care regimen, or are no longer appropriate or indicated.  Deprescribing is an integral part of medication review for older patients, and it allows for stopping the administration of certain medications to improve the quality of life and eliminate risks such as cognitive and functional decline, non-adherence and adverse drug reactions.

Dr. Xisco Reus Perello also spoke on Streamlining medications in older adults: A guided approach to safe deprescribing. He explained that over the years, there has been an appreciable increase in life expectancy as a result of improved healthcare delivery and development of new medications.  Polypharmacy has also increased with its attendant issues especially in older patients.  Although deprescribing demands an enhanced clinician-patient relationship and can be time-consuming, it can contribute to improving quality of life through the withdrawal of some medications which are either no longer necessary or are inherently harmful.  The involvement of pharmacists in medication reviews and the use of appropriate guidelines, as done in Australia, bring out the full benefits of deprescribing.

Prof. Perello also stated that some challenges to effective deprescribing include difficulty in accessing patients records due to digital issues, inadequate information to primary care providers from specialists, frequent change of healthcare providers and facilities, and inadequate patient medical history.  Robinson, Mokrzecki, & Mallett (2024) explained that there are hinderances to effective deprescribing – inadequate knowledge and appreciation of the process, conflicting care expectations, several healthcare providers, patients’ varying life priorities, resource limitations, as well as institutional differences (health-system factors). Prof. Perello emphasised that Pharmacists can play vital roles in medication reviews.  Pharmacists can educate patients on medicine use and adherence, advice on selection and dosage of medicines, alternatives during stock-outs, reconciliation of medication during transitions of care, and promote preventative care and healthy living.  Updated guidelines are vital in effective deprescribing.

Prof. Anton Pottegård also addressed the meeting on Big data: Data analytics to identify deprescribing opportunities and influence healthcare. He stressed that deprescribing, a considered decrease and stoppage of medicines, is a vital part of patient care. Prof. Pottegård explained the difficulty and challenges inherent in using big data to support deprescribing including misinterpretation and confounding terminology, impact of underlying mortality on polypharmacy, and the use of routinely collected data in the study of deprescribing.

As indicated earlier, polypharmacy has inherent issues.  Robinson et al. (2024) explained that polypharmacy is basically the concurrent use of 5 or more medications that include OTC, prescription and complementary medicines.  Though clinically apt, there can be inherent risks that affect mostly the aged including drug-drug interactions, ADRs, and mortality.  There are also financial implications.

Medication review, with the aim to optimise medication use and improve patient outcomes, in an individual-centred approach, is applied to resolve the risks associated with polypharmacy (Robinson et al., 2024).  Zhou, Chen & Tian (2023) concluded that several facilities frequently utilised pharmacists’ medication reviews.

In deprescribing, there must be a conscious and deliberate effort to involve all the relevant parties to arrive at a shared decision for the process. There must be clear guidelines to identify older people, especially those getting to end-of-life, and other candidates for the deprescribing process (Curtin, Gallagher & O’Mahony, 2021).  Any successful deprescribing must involve the patient, family and the carers, and must be planned (Frank et al., 2014).

The focus should be to avoid compromising health and quality of life whilst reducing the burden and drug-related morbidity in older patients.  The healthcare team needs to appreciate that it must go beyond the restoration and maintenance of health in older patients especially when there is obvious decline in health and when the target of medical care has been reached. In such a situation older people would be better off taking fewer medications (Curtin et al. 2021).

\Frank et al. (2014) also indicated that where the focus is improvement of function and symptoms management rather than targeting specific diseases, most patients can tolerate withdrawal of certain medications or dosage reduction with improvement in quality of life and without any serious implications.  Robinson et al. (2024) concluded that deprescribing helps to minimise the pill burden and harm from side effects, eliminates medications with unachieved or minimal benefits, enhances adherence, reduces medication interactions and cost of treatment.  Zhou et al. (2023) explains that medication adherence can be enhanced whilst the occurrence of potentially inappropriate medication (PIM) and potentially prescription omission (PPO) in older patients can be reduced when deprescribing interventions are instituted.  Prof. Perello stated that PIMs can also be identified through consistent medication reviews.

Multiple factors which are highly inter-related influence the decision of healthcare professionals in deciding on deprescribing. These include the healthcare professionals’ self-assurance and teamwork (Lundby, Graabæk, Ryg, Søndergaard, Pottegård, & Nielsen, 2019).

Again, deprescribing can be facilitated by opportunities (patients’ request to reduce number of medications and to manage own health, change of care providers); triggers (increasing comorbidities, evidence of cognitive impairment, number of medications, patient request);  facilitating influences (use of multidisciplinary team including a pharmacist, provision of adequate resources including time); and use of strategies – patient education, gradual change of medication regimen, involvement of specialists (Robinson et al.. 2024).  The use of guidelines can be helpful.

Most often in old age, multiple diseases are inevitable. Although quality of life can be improved with multiple medicines, polypharmacy can negatively impact the quality of life. Regular medication review by a multidisciplinary team that includes a pharmacist can facilitate the use of deprescription to reduce and stop the use of some medications that are no longer helpful or potentially harmful, that would result in improved quality of life and well-being of older patients.

REFERENCES

  1. Curtin, D., Gallagher, P., & O’Mahony, D. (2021). Deprescribing in older people approaching end-of-life: development and validation of STOPPFrail version 2. Age and ageing, 50(2), 465-471.
  2. Frank, C., & Weir, E. (2014). Deprescribing for older patients. Cmaj, 186(18), 1369-1376.
  3. Lundby, C., Graabæk, T., Ryg, J., Søndergaard, J., Pottegård, A., & Nielsen, D. S. (2019). Health care professionals’ attitudes towards deprescribing in older patients with limited life expectancy: a systematic review. British journal of clinical pharmacology, 85(5), 868-892.
  4. Robinson, M, Mokrzecki, S, & Mallett, A (2024). POLYPHARMACY, W. I. Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review.
  5. Zhou, D., Chen, Z., & Tian, F. (2023). Deprescribing interventions for older patients: a systematic review and meta-analysis. Journal of the American Medical Directors Association, 24(11), 1718-1725.