Which Drugs Should Be Deprescribed in the Elderly?

Tom G. Bartol, NP


July 02, 2015

What Are Priorities for Deprescribing for Elderly Patients? Capturing the Voice of Practitioners: A Modified Delphi Process

Farrell B, Tsang C, Raman-Wilms L, Irving H, Conklin J, Pottie K
PLoS One. 2015;10:e0122246

Which Drugs Should Be Discontinued?

This study from Canada examined polypharmacy and inappropriate medication use in the elderly. The investigators' vision was to develop deprescribing guidelines for the elderly. Deprescribing was defined as tapering, reducing, or stopping medications not deemed necessary or safe, when feasible. Using a modified Delphi process, they sought to develop a list of medications used in the elderly for which deprescribing should be prioritized.

The process involved three rounds of surveys of up to 64 Canadian clinical experts in medicine, pharmacy, and nursing who had expertise in geriatric pharmacotherapy. Approximately 15% of survey respondents were nurse practitioners. Pharmacists provided the bulk of the responses (60%). The remaining respondents were geriatricians, averaging about 10%, and family physicians (15%).

The survey process developed five main criteria for determining priorities for deprescribing guidelines:

  • Risks associated with continuing the drug;

  • Questions about ongoing indication for or benefit of the drug;

  • Prevalence of overuse of the drug;

  • Challenge in stopping the drug; and

  • The availability of other treatment options.

A final list of medication classes to be prioritized for deprescribing in the elderly was produced. Topping the list were benzodiazepines, followed by atypical antipsychotics, statins, tricyclic antidepressants, and proton pump inhibitors. The full list consisted of 14 different medications.

The study authors maintain that the current culture of healthcare facilitates diagnosing and prescribing but pays relatively little attention to deprescribing or reducing chronic medications. They recommend the development of evidence-based deprescribing guidelines for these medication classes.


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