The Process of Deprescribing in Older Adults With Potentially Inappropriate Medication or Polypharmacy: A Scoping Review.

OBJECTIVES

Deprescribing is increasingly recognized as an effective strategy for reducing potentially inappropriate medication (PIM) use and polypharmacy in older adults. However, existing deprescribing frameworks often lack detailed operational guidance, which may hinder their routine implementation in clinical practice. To systematically map and characterize the reported deprescribing processes in older adults with PIM use or polypharmacy and identify gaps in their operationalization.

METHODS

PubMed, Embase (Ovid), and Web of Science were comprehensively searched for studies describing deprescribing processes in older adults with PIM use or polypharmacy. The reported processes were evaluated against Reeve's patient-centered deprescribing framework, which comprises five sequential steps.

RESULTS

A total of 92 studies describing deprescribing processes were included. Although 91 studies (98.91%) provided at least a partial description of the deprescribing process, only 1 study reported all five steps of Reeve's framework in detail. The step of planning and initiating medication withdrawal was the most frequently and thoroughly described (63/92, 68.97%). In contrast, operational guidance for determining whether a medication could be ceased and prioritizing medications for discontinuation was rarely reported, with only 7 studies (7.61%) providing sufficient detail. Patient involvement in developing the deprescribing plan was also inconsistently reported, with nearly half of the studies inadequately addressing this aspect.

CONCLUSIONS

Deprescribing processes are incompletely and inconsistently operationalized in the literature. In particular, guidance on cessation decisions, medication prioritization, and patient engagement remains limited. Future deprescribing frameworks should provide explicit, stepwise, and patient-centered operational guidance to facilitate consistent implementation in routine clinical practice.