Outcomes of deprescribing for people with life-limiting conditions: A systematic review.

BACKGROUND

Polypharmacy and inappropriate medication are common amongst people with life-limiting conditions. Whilst deprescribing may help reduce these medication-related issues, supporting evidence in this population group is limited.

AIM: To synthesise evidence on the outcomes of deprescribing in people with life-limiting conditions.

DESIGN

Systematic review.

DATA SOURCE: MEDLINE, Embase, Scopus, PsycINFO and CINAHL were searched. Original studies published between Jan 2000 and Dec 2024 in English were included.

RESULT: A total of 17,457 hits were screened, of which 46 original studies met the inclusion criteria. Most eligible studies were pre-post interventional (n = 14) or cohort studies (n = 14), conducted primarily in nursing homes or long-term care facilities (n = 20) and hospitals (n = 16). The majority originated from North America (n = 20) and Australia (n = 7). A wide range of outcome variables were examined, with a primary focus on clinical outcomes. All studies assessing the impact on the number of medications used reported either a reduction in overall medication burden or inappropriate medications (n = 15), or no significant change (n = 3). Regarding mortality, most studies (10 studies) reported no impact, while 3 studies each reported increased and decreased mortality. For other outcomes, the majority of studies reported that deprescribing had no effect.

CONCLUSION

This systematic review suggests that deprescribing offers some benefits, including reduced medication burden and costs in people with life-limiting conditions. While there is no strong evidence for harm, a small proportion of patients reported increased risks, so careful monitoring is essential. Further research should explore how deprescribing outcomes vary by disease condition and medication type.