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International Journal of Clinical Pharmacy

, Volume 41, Issue 1, pp 167–178 | Cite as

DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities

  • Nagham AilabouniEmail author
  • Dee Mangin
  • Prasad S. Nishtala
Research Article

Abstract

Background Prolonged use of anticholinergic and sedative medicines is correlated with worsening cognition and physical function decline. Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Objective This study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model; in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes. Setting Three residential care facilities. Methods The intervention involved a New Zealand registered pharmacist utilising peer-reviewed deprescribing guidelines to recommend targeted deprescribing of anticholinergic and sedative medicines to GPs. Main outcome measure The change in the participants’ Drug Burden Index (DBI) total and DBI ‘as required’ (PRN) was assessed 3 and 6 months after implementing the deprescribing intervention. Results Seventy percent of potential participants were recruited for the study (n = 46), and 72% of deprescribing recommendations suggested by the pharmacist were implemented by General Pratitioners (p = 0.01; Fisher’s exact test). Ninety-six percent of the residents agreed to the deprescribing recommendations, emphasising the importance of patient centred approach. Deprescribing resulted in a significant reduction in participants’ DBI scores by 0.34, number of falls and adverse drug reactions, 6 months post deprescribing. Moreover, participants reported lower depression scores and scored lower frailty scores 6 months after deprescribing. However, cognition did not improve; nor did participants’ reported quality of life. Conclusion This patient-centred deprescribing approach, demonstrated a high uptake of deprescribing recommendations and success rate. After 6 months, significant benefits were noted across a range of important health measures including mood, frailty, falls and reduced adverse reactions. This further supports deprescribing as a possible imperative to improve health outcomes in older adults.

Keywords

Anticholinergic Deprescribing Drug burden index Elderly Feasibility study New Zealand Sedatives 

Notes

Acknowledgements

The authors appreciate the co-operation of the residential care provider who agreed to take part in the study.

Funding

This study was funded by the Lotteries Health Research (LHR). No other funding was received for this study.

Conflicts of interest

The author(s) declare no competing interests and are responsible for this report’s content.

Supplementary material

11096_2019_784_MOESM1_ESM.docx (46 kb)
Supplementary material 1 (DOCX 46 kb)

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Nagham Ailabouni
    • 1
    Email author
  • Dee Mangin
    • 2
    • 3
  • Prasad S. Nishtala
    • 4
  1. 1.School of PharmacyUniversity of WashingtonSeattleUSA
  2. 2.University of OtagoChristchurchNew Zealand
  3. 3.David Braley Nancy Gordon, Chair in Family MedicineMcMaster UniversityHamiltonCanada
  4. 4.University of BathBathUK

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