Optimizing Medication Use in Older Adults in Primary Care: A Systematic Review of The Effectiveness of Deprescribing Interventions

Background The increasing prevalence of polypharmacy and potentially inappropriate medications (PIMs) among older adults in Primary Health Care (PHC) poses significant risks to patient safety and quality of life. This systematic review aimed to evaluate the effectiveness and applicability of various deprescribing techniques in PHC, specifically targeting the reduction in long-term medication use, decrease in PIMs, and resolution of potentially inappropriate prescribing. Methods We conducted a systematic review of randomized clinical trials published between 2010 and 2023. Searches were performed across PubMed, EMBASE, and LILACS databases. A narrative synthesis was employed to present the findings, and the quality of included studies was rigorously assessed using the Cochrane Risk of Bias Tool (RoB 2) and the GRADE system. Primary outcomes of interest included reduction in long-term medication use, decrease in PIMs, and resolution of potentially inappropriate prescribing. Secondary outcomes examined changes in hospital admissions and mortality rates Results From an initial screening of 100 unique citations, thirteen studies met the inclusion criteria. These studies investigated a range of deprescribing interventions, including automated algorithms, multidisciplinary approaches, educational activities, and medication reviews conducted by pharmacists and physicians. Automated algorithms and pharmacist-led interventions consistently demonstrate significant efficacy in reducing potentially inappropriate medications. In contrast, multidisciplinary interventions and educational activities yielded mixed results regarding overall medication reduction. Notably, medication reviews performed solely by family physicians did not show efficacy in reducing PIMs. While no significant effects on mortality were observed across any interventions, one study focusing on educational activities reported a reduction in hospital admissions. Conclusions Deprescribing techniques, particularly automated algorithms and pharmacist-led interventions, appear effective in reducing the use of potentially inappropriate medications among older adults in PHC. Although these interventions are suggested to be safe, their long-term clinical benefits, beyond PIM reduction, are not yet clearly established. Future research should prioritize standardizing outcomes and conducting studies designed to comprehensively assess the long-term clinical impacts of deprescribing