End of life care for frail older people; do we have a consensus
guideline on deprescribing?
Abstract
Background: Deprescribing interventions have shown to improve medication
appropriateness in older people. However, the evidence on the actual
benefits and risks of deprescribing in older adults at the end of life
are limited. Due to the lack of evidence on the safety and efficacy of
medication in these populations, the most appropriate deprescribing
approach is unclear. We aimed to conduct a narrative review of research
on existing deprescribing guidelines targeted to frail older people at
the end of life. Methods: A literature search was conducted in PubMed,
Embase, CINAHL and Google Scholar to identify studies from inception to
January 2021 on deprescribing guidelines/tools for frail older adults
near end-of-life or palliative situation or life-limiting illnesses or
limited life expectancy were included. Results: A total of nine studies
were included. The deprescribing guidelines used in these studies were
helpful to some extent in optimising medications in patients with
limited life expectancy and life-limiting illnesses. Some of them have
been tested in prospective studies that showed their usefulness in
minimising the number of potentially inapproapriate medications. These
studies however were not randomised and involved small sample sizes and
had little insight into the clinical outcomes of using these tools.
Conclusions: The existing tools and guidelines on deprescribing do not
represent the end of life care nor address the medication
appropriateness among individuals with a specific condition. An explicit
and rigorous consensus-based guideline needs to be developed and tested
in a well-designed clinical trial to measure clinically significant
outcomes