NAVIGATING POLYPHARMACY IN AGING POPULATIONS: A SYSTEMATIC REVIEW OF DEPRESCRIBING INTERVENTIONS AND ITS IMPACT ON CLINICAL OUTCOMES

Background: Polypharmacy, prescription of five or more drugs, is common in geriatric care and has been linked to increased risk of adverse drug reactions (ADRs), hospitalization, and reduced quality of life. Deprescribing, a structured approach to supervised discontinuation of inappropriate medications, is a growing trend but remains a debatable notion due to lack of consensus and literature gaps. The objective of this narrative review was to summarize the evidence related to the impact of deprescribing interventions on clinical outcomes. Methods: Systematic searching of PubMed, Cochrane Library, ClinicalTrials.gov, and the WHO International Clinical Trials Registry was done. Studies were then categorized according to study designs with 10 randomized controlled trials (RCTs), 7 cohort studies, and 11 systematic reviews. Studies without a comparator group, qualitative studies, and case reports were excluded. Due to the given heterogeneity of studies, a narrative synthesis of study results was done, and outcomes were summarized according to subgroups (patient characteristics, intervention type and setting). Four major outcomes were assessed, which included adverse drug reactions, hospitalization rates, medication Burden, and Quality of Life. Bias was assessed according to the Newcastle-Ottawa Scale for observational studies and Cochrane Risk of Bias Tool (ROB 2) for RCTs. Results: Results of the Deprescribing interventions in older adults have yielded mixed outcomes across various health parameters. While many studies highlight various benefits of deprescribing such as reductions in adverse drug reactions (ADRs) and medication burden (McDonald et al., 2022; Quek et al., 2024), other studies report limited or no significant effects on hospitalization rates and quality of life (Ibrahim et al., 2021; Jackson & Patel, 2020). Differences in various study designs, populations, and methodologies of the included studies may lead to these inconsistencies. Therefore, standardized protocols and further research is imperative to fully recognize and optimize the effect of deprescribing interventions. Conclusion: Despite the advantages of deprescribing, heterogeneity of protocols, inconsistent reporting of outcomes, and short follow-ups limit the evidence. Standardized guidelines and longer studies are required to optimize deprescribing. Keywords: deprescribing interventions; clinical outcomes; narrative synthesis, older adults; polypharmacy; systematic review