Evaluation of deprescribing services in frail patients: A Systematic Review

Background: Deprescribing, a process of dose reduction or withdrawal of inappropriate medication that no longer has benefit, is a proposed intervention in the care of older adults living with frailty. Objective/Aim: To evaluate safety, clinical impact, and long-term outcomes of deprescribing services in frail patients, including the barriers and enablers of deprescribing services in such settings. Methods: A systematic review was performed in Scopus, CINAHL PLUS (EBSCO), MEDLINE (OVID and EMBASE) and Cochrane library. The Mixed Methods Appraisal tool (MMAT) was used for appraising the methodological quality of the included papers. Studies were selected after title, abstract, and full text screening, with independent review. Thematic analysis was used for analysing data from the selected articles. Results: 590 unique titles were identified, with 9 (6 trials, 1 interview, 1 survey, and 1 designed-delay study) meeting inclusion and exclusion criteria. Five mains descriptive themes have been identified: barriers, enablers, deprescribing services in frailty, safety management and deprescribing outcomes. Conclusion: This study provides limited evidence that deprescribing services in frail patients are effective in reducing the number of potentially inappropriate medications and medication costs. To further improve deprescribing in frailty, clinicians should consider a customised safety plan and benefit/risk assessment for each patient.