Deprescribing anticholinergic and sedative drugs to reduce polypharmacy in frail older adults living in the community: a randomized controlled trial

Hamish Jamieson, Prasad S Nishtala, Hans Ulrich Bergler, Susan K Weaver, John W Pickering, Nagham J Ailabouni, Rebecca Abey-Nesbit, Carolyn Gullery, Joanne Deely, Susan B Gee, Sarah N Hilmer, Dee Mangin

Research output: Contribution to journalArticlepeer-review

6 Citations (SciVal)

Abstract

Background: Polypharmacy is associated with poor outcomes in older adults. Targeted deprescribing of anticholinergic and sedative medications may improve health outcomes for frail older adults. Our pharmacist-led deprescribing intervention was a pragmatic 2-arm randomized controlled trial stratified by frailty. We compared usual care (control) with the intervention of pharmacists providing deprescribing recommendations to general practitioners. Methods: Community-based older adults (≥65 years) from 2 New Zealand district health boards were recruited following a standardized interRAI needs assessment. The Drug Burden Index (DBI) was used to quantify the use of sedative and anticholinergic medications for each participant. The trial was stratified into low, medium, and high-frailty. We hypothesized that the intervention would increase the proportion of participants with a reduction in DBI ≥ 0.5 within 6 months. Results: Of 363 participants, 21 (12.7%) in the control group and 21 (12.2%) in the intervention group had a reduction in DBI ≥ 0.5. The difference in the proportion of -0.4% (95% confidence interval [CI]: -7.9% to 7.0%) provided no evidence of efficacy for the intervention. Similarly, there was no evidence to suggest the effectiveness of this intervention for participants of any frailty level. Conclusion: Our pharmacist-led medication review of frail older participants did not reduce the anticholinergic/sedative load within 6 months. Coronavirus disease 2019 (COVID-19) lockdown measures required modification of the intervention. Subgroup analyses pre- and post-lockdown showed no impact on outcomes. Reviewing this and other deprescribing trials through the lens of implementation science may aid an understanding of the contextual determinants preventing or enabling successful deprescribing implementation strategies.

Original languageEnglish
Pages (from-to)1692-1700
Number of pages9
JournalJournal of Gerontology: series A - Medical Sciences
Volume78
Issue number9
Early online date24 Jan 2023
DOIs
Publication statusPublished - 30 Sept 2023

Data Availability Statement

Study materials are provided as Supplementary Materials. New Zealand’s ethics laws do not permit free sharing of data. However, aggregate and deidentified data may be provided to collaborating research groups under an appropriate data-sharing agreement.

Clinical Trials Registration Number: ACTRN12618000729224

Keywords

  • Drug Burden Index
  • Frailty
  • interRAI

ASJC Scopus subject areas

  • Medicine(all)

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