Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature
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SYSTEMATIC REVIEW
Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature Jennifer A. Pruskowski1 · Sydney Springer1,2,3 · Carolyn T. Thorpe2,4 · Michele Klein‑Fedyshin5 · Steven M. Handler6
© Springer Nature Switzerland AG 2019
Abstract Background Deprescribing has been shown to reduce potentially inappropriate or unnecessary medications; however, whether these benefits translate into improved quality of life (QOL) is uncertain. Objective The objective of this study was to isolate the impact of deprescribing on patient or designated representative reported QOL; satisfaction with care (SWC) and emergency department (ED) visits and hospitalizations were also investigated to further explore this question. Methods This systematic review searched the Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE, and EMBASE from database inception until November 2017. Randomized controlled trials and non-randomized prospective studies of older adults (> 65 years or older) and older persons with life-limiting conditions were included. Two reviewers independently assessed the search results and performed risk of bias assessments. Data on QOL, SWC, and ED visits and hospitalizations were extracted from all identified studies. Risk of bias of individual studies was assessed using measures recommended by the Cochrane Collaboration. Results Screening of 6543 eligible records identified 12 studies within 13 articles. In ten studies investigating the reduction of at least one medication deprescribed, compared with usual care, all but two found no difference in QOL. To date there has only been one study examining the impact of deprescribing on SWC, which was found to be not statistically significant. Four studies exploring the impact of deprescribing on ED visits and hospitalizations also found no significant difference. However, many studies were found to have a higher performance, detection, or other bias. We found considerable heterogeneity in patient populations, targeted medications for deprescribing, and QOL measurements used in these studies. Conclusion Based on a limited number of studies with varying methodological rigor, deprescribing may not significantly improve QOL or SWC; however, it may not contribute to additional ED visits and hospitalizations. Future controlled studies are needed.
1 Introduction Older adults often carry a significant medication burden. In a sample of Medicare beneficiaries discharged from an acute hospitalization to a skilled nursing facility, older adults were prescribed an average of 14 medications [1]. Unfortunately, many of these medications are potentially inappropriate or unnecessary. A 2016 systematic review of inappropriate medication use found almost 50% of older nursing home residents are exposed to such medications, and a 2018 Electronic supplementary material The online version of this article (https://doi.org/10.1007/s40266-019-00717-1) contains supplementary material, which is available to authorized users. * Jennifer A.
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