Skip to main content

Advertisement

SpringerLink
Log in

Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature

  • Systematic Review
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Background

Deprescribing has been shown to reduce potentially inappropriate or unnecessary medications; however, whether these benefits translate into improved quality of life (QOL) is uncertain.

Objective

The objective of this study was to isolate the impact of deprescribing on patient or designated representative reported QOL; satisfaction with care (SWC) and emergency department (ED) visits and hospitalizations were also investigated to further explore this question.

Methods

This systematic review searched the Cochrane Library, Cumulative Index to Nursing and Allied Health (CINAHL), MEDLINE, and EMBASE from database inception until November 2017. Randomized controlled trials and non-randomized prospective studies of older adults (> 65 years or older) and older persons with life-limiting conditions were included. Two reviewers independently assessed the search results and performed risk of bias assessments. Data on QOL, SWC, and ED visits and hospitalizations were extracted from all identified studies. Risk of bias of individual studies was assessed using measures recommended by the Cochrane Collaboration.

Results

Screening of 6543 eligible records identified 12 studies within 13 articles. In ten studies investigating the reduction of at least one medication deprescribed, compared with usual care, all but two found no difference in QOL. To date there has only been one study examining the impact of deprescribing on SWC, which was found to be not statistically significant. Four studies exploring the impact of deprescribing on ED visits and hospitalizations also found no significant difference. However, many studies were found to have a higher performance, detection, or other bias. We found considerable heterogeneity in patient populations, targeted medications for deprescribing, and QOL measurements used in these studies.

Conclusion

Based on a limited number of studies with varying methodological rigor, deprescribing may not significantly improve QOL or SWC; however, it may not contribute to additional ED visits and hospitalizations. Future controlled studies are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Saraf AA, Petersen AW, Simmons SF, et al. Medications associated with geriatric syndromes and their prevalence in older hospitalized adults discharged to skilled nursing facilities. J Hosp Med. 2016;11:694–700.

    PubMed  Google Scholar 

  2. Morin L, Laroche ML, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(862):e1–9.

    Google Scholar 

  3. Redston MR, Hilmer SN, McLachlan AJ, Clough AJ, Gnjidic D. Prevalence of potentially inappropriate medication use in older inpatients with and without cognitive impairment: a systematic review. J Alzheimers Dis. 2018;61:1639–52.

    PubMed  Google Scholar 

  4. Harrison SL, O’Donnell LK, et al. Associations between the Drug Burden Index, potentially inappropriate medications and quality of life in residential aged care. Drugs Aging. 2018;35:83–91.

    PubMed  Google Scholar 

  5. Marcum ZA, Gellad WF. Medication adherence to multidrug regimens. Clin Geriatr Med. 2012;28:287–300.

    PubMed  PubMed Central  Google Scholar 

  6. Pérez-Jover V, Mira JJ, Carratala-Munuera C, et al. Inappropriate use of medication by elderly, polymedicated, or multipathological patients with chronic diseases. Int J Environ Res Public Health. 2018;15(2):E310.

    PubMed  Google Scholar 

  7. Eckerblad J, Theander K, Ekdahl A, et al. Symptom burden in community-dwelling older people with multimorbidity: a cross-sectional study. BMC Geriatr. 2015;15:1.

    PubMed  PubMed Central  Google Scholar 

  8. Deshields TL, Potter P, Olsen S, Liu J. The persistence of symptom burden: symptom experience and quality of life of cancer patients across one year. Support Care Cancer. 2014;22:1089–96.

    PubMed  Google Scholar 

  9. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827–34.

    PubMed  Google Scholar 

  10. Thillainadesan J, Gnjidic D, Green S, Hilmer SN. Impact of deprescribing interventions in older hospitalised patients on prescribing and clinical outcomes: a systematic review of randomised trials. Drugs Aging. 2018;35:303–19.

    CAS  PubMed  Google Scholar 

  11. Pruskowski J, Handler SM. The DE-PHARM Project: a pharmacist-driven deprescribing initiative in a nursing facility. Consult Pharm. 2017;32:468–78.

    PubMed  Google Scholar 

  12. Wouters H, Scheper J, Koning H, et al. Discontinuing inappropriate medication use in nursing home residents: a cluster randomized controlled trial. Ann Intern Med. 2017;167:609–17.

    PubMed  Google Scholar 

  13. Reeve E, To J, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging. 2013;30(10):793–807.

    PubMed  Google Scholar 

  14. Stevenson J, Abernethy AP, Miller C, Currow DC. Managing comorbidities in patients at the end of life. BMJ. 2004;329:909–12.

    PubMed  PubMed Central  Google Scholar 

  15. Marcum ZA, Amuan ME, Hanlon JT, et al. Prevalence of unplanned hospitalizations caused by adverse drug reactions in older veterans. J Am Geriatr Soc. 2012;60:34–41.

    PubMed  Google Scholar 

  16. Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta-analysis. Br J Clin Pharmacol. 2016;82:583–623.

    PubMed  PubMed Central  Google Scholar 

  17. Bandayrel K, Johnston BC. Recent advances in patient and proxy-reported quality of life research. Health Qual Life Outcomes. 2014;12:110.

    PubMed  PubMed Central  Google Scholar 

  18. Bladh L, Ottosson E, Karlsson J, Klintberg L, Wallerstedt SM. Effects of a clinical pharmacist service on health-related quality of life and prescribing of drugs: a randomised controlled trial. BMJ Qual Saf. 2011;20:738–46.

    PubMed  Google Scholar 

  19. Gallagher PF, O’Connor MN, O’Mahony D. Prevention of potentially inappropriate prescribing for elderly patients: a randomized controlled trial using STOPP/START criteria. Clin Pharmacol Ther. 2011;89:845–54.

    CAS  PubMed  Google Scholar 

  20. Gillespie U, Alassaad A, Hammarlund-Udenaes M, et al. Effects of pharmacists’ interventions on appropriateness of prescribing and evaluation of the instruments’ (MAI, STOPP and STARTs’) ability to predict hospitalization—analyses from a randomized controlled trial. PLoS One. 2013;8:e62401.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Spinewine A, Swine C, Dhillon S, et al. Effect of a collaborative approach on the quality of prescribing for geriatric inpatients: a randomized, controlled trial. J Am Geriatr Soc. 2007;55:658–65.

    PubMed  Google Scholar 

  22. Van der Linden L, Decoutere L, Walgraeve K, et al. Combined use of the Rationalization of home medication by an Adjusted STOPP in older Patients (RASP) list and a pharmacist-led medication review in very old inpatients: impact on quality of prescribing and clinical outcome. Drugs Aging. 2017;34:123–33.

    PubMed  Google Scholar 

  23. Institute of Medicine (US) Committee on Standards for Systematic Reviews of Comparative Effectiveness Research; Eden J, Levit L, Berg A, et al., editors. Finding what works in health care: standards for systematic reviews. Washington, DC: National Academies Press (US); 2011. https://doi.org/10.17226/13059. https://www.ncbi.nlm.nih.gov/books/NBK209518/. Accessed 23 Sept 2019.

  24. Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Ann Intern Med. 2009;151:W65–94.

    PubMed  Google Scholar 

  25. Higgins JP, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.

    PubMed  PubMed Central  Google Scholar 

  26. Sterne JA, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;355:i4919.

    PubMed  PubMed Central  Google Scholar 

  27. Beer C, Loh PK, Peng YG, Potter K, Millar A. A pilot randomized controlled trial of deprescribing. Ther Adv Drug Saf. 2011;2:37–43.

    PubMed  PubMed Central  Google Scholar 

  28. Bergh S, Selbæk G, Engedal K. Discontinuation of antidepressants in people with dementia and neuropsychiatric symptoms (DESEP study): double blind, randomised, parallel group, placebo controlled trial. BMJ. 2012;344:e1566.

    PubMed  Google Scholar 

  29. Bourgeois J, Elseviers MM, Van Bortel L, Petrovic M, Vander Stichele RH. Feasibility of discontinuing chronic benzodiazepine use in nursing home residents: a pilot study. Eur J Clin Pharmacol. 2014;70(10):1251–60.

    CAS  PubMed  Google Scholar 

  30. Kutner JS, Blatchford PJ, Taylor DH Jr, et al. Safety and benefit of discontinuing statin therapy in the setting of advanced, life-limiting illness: a randomized clinical trial. JAMA Intern Med. 2015;175:691–700.

    PubMed  PubMed Central  Google Scholar 

  31. Lopez-Peig C, Mundet X, Casabella B, del Val JL, Lacasta D, Diogene E. Analysis of benzodiazepine withdrawal program managed by primary care nurses in Spain. BMC Res Notes. 2012;5:684.

    CAS  PubMed  PubMed Central  Google Scholar 

  32. Moonen JE, Foster-Dingley JC, de Ruijter W, et al. Effect of discontinuation of antihypertensive treatment in elderly people on cognitive functioning—the DANTE Study Leiden: a randomized clinical trial. JAMA Intern Med. 2015;175:1622–30.

    PubMed  Google Scholar 

  33. Polinder S, Boyé ND, Mattace-Raso FU, et al. Cost-utility of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial. BMC Geriatr. 2016;16:179.

    PubMed  PubMed Central  Google Scholar 

  34. Potter K, Flicker L, Page A, Etherton-Beer C. Deprescribing in frail older people: a randomised controlled trial. PLoS One. 2016;11:e0149984.

    PubMed  PubMed Central  Google Scholar 

  35. Sakakibara M, Igarashi A, Takase Y, Kamei H, Nabeshima T. Effects of prescription drug reduction on quality of life in community-dwelling patients with dementia. J Pharm Pharm Sci. 2015;18:705–12.

    PubMed  Google Scholar 

  36. Ulfvarson J, Adami J, Wredling R, Kjellman B, Reilly M, von Bahr C. Controlled withdrawal of selective serotonin reuptake inhibitor drugs in elderly patients in nursing homes with no indication of depression. Eur J Clin Pharmacol. 2003;59:735–40.

    CAS  PubMed  Google Scholar 

  37. Boyé ND, van der Velde N, de Vries OJ, et al. Effectiveness of medication withdrawal in older fallers: results from the Improving Medication Prescribing to reduce Risk Of FALLs (IMPROveFALL) trial. Age Ageing. 2017;46:142–6.

    PubMed  Google Scholar 

  38. Garfinkel D, Zur-Gil S, Ben-Israel J. The war against polypharmacy: a new cost-effective geriatric-palliative approach for improving drug therapy in disabled elderly people. Isr Med Assoc J. 2007;9:430–4.

    PubMed  Google Scholar 

  39. Jondeau G, Neuder Y, Eicher JC, et al. B-CONVINCED: beta-blocker CONtinuation vs. INterruption in patients with Congestive heart failure hospitalizED for a decompensation episode. Eur Heart J. 2009;30:2186–92.

    CAS  PubMed  Google Scholar 

  40. Cantril H. The pattern of human concerns. New Brunswick: Rutgers University Press; 1965.

    Google Scholar 

  41. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med. 2001;33:337–43.

    CAS  PubMed  Google Scholar 

  42. Cohen SR, Mount BM, Strobel MG, Bui F. The McGill Quality of Life Questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliat Med. 1995;9:207–19.

    CAS  PubMed  Google Scholar 

  43. Torisson G, Stavenow L, Minthon L, Londos E. Reliability, validity and clinical correlates of the Quality of Life in Alzheimer’s disease (QoL-AD) scale in medical inpatients. Health Qual Life Outcomes. 2016;14:90.

    PubMed  PubMed Central  Google Scholar 

  44. Hagell P, Westergren A, Årestedt K. Beware of the origin of numbers: standard scoring of the SF-12 and SF-36 summary measures distorts measurement and score interpretations. Res Nurs Health. 2017;40:378–86.

    PubMed  Google Scholar 

  45. Lins L, Carvalho FM. SF-36 total score as a single measure of health-related quality of life: scoping review. SAGE Open Med. 2016;4:2050312116671725. https://doi.org/10.1177/2050312116671725.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Dills H, Shah K, Messinger-Rapport B, Bradford K, Syed Q. Deprescribing medications for chronic diseases management in primary care settings: a systematic review of randomized controlled trials. J Am Med Dir Assoc. 2018;19(923–935):e2.

    Google Scholar 

  47. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in the elderly. Expert Opin Drug Saf. 2014;13(1):57–65.

    PubMed  Google Scholar 

  48. Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946–52.

    PubMed  PubMed Central  Google Scholar 

  49. Lee M, Saver JL, Wu YL, et al. Utilization of statins beyond the initial period after stroke and 1-year risk of recurrent stroke. J Am Heart Assoc. 2017;6:e005658.

    PubMed  PubMed Central  Google Scholar 

  50. Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes towards deprescribing in older Medicare beneficiaries in the United States. JAMA Intern Med. 2018;178:1673–80.

    PubMed  PubMed Central  Google Scholar 

  51. Kuntz J, Kouch L, Christian D, Peterson PL, Gruss I. Barriers and facilitators to the deprescribing of nonbenzodiazepine sedative medications among older adults. Perm J. 2018;22:17–157.

    PubMed  PubMed Central  Google Scholar 

  52. Dou C, Rebane J, Bardal S. Intervention to improve benzodiazepine tapering success in the elderly: a systematic review. Aging Ment Health. 2018;16:1–6.

    Google Scholar 

  53. Payakachat N, Ali MM, Tilford JM. Can the EQ-5D detect meaningful change? A systematic review. Pharmacoeconomics. 2015;33:1137–54.

    PubMed  PubMed Central  Google Scholar 

  54. Glasziou P, Alexander J, Beller E, Clarke P. Which health-related quality of life score? A comparison of alternative utility measures in patients with type 2 diabetes in the ADVANCE trial. Health Qual Life Outcomes. 2007;5:21.

    PubMed  PubMed Central  Google Scholar 

  55. Tseng HM, Lee CH, Chen YJ, Hsu HH, Huang LY, Huang JL. Developing a measure of medication-related quality of life for people with polypharmacy. Qual Life Res. 2016;25:1295–302.

    PubMed  Google Scholar 

  56. Thompson W, Reeve E, Moriarty F, et al. Deprescribing: future directions for research. Res Social Adm Pharm. 2019;15:801–5.

    PubMed  Google Scholar 

  57. Mohammed MA, Moles RJ, Chen TF. Pharmaceutical care and health related quality of life outcomes over the past 25 years: have we measured dimensions that really matter? Int J Clin Pharm. 2018;40:3–14.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. School of Pharmacy, University of Pittsburgh, 3600 Forbes Avenue at Meyran Avenue, Suite 308.15, Pittsburgh, PA, 15213, USA

    Jennifer A. Pruskowski & Sydney Springer

  2. Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA, USA

    Sydney Springer & Carolyn T. Thorpe

  3. College of Pharmacy, University of New England, Portland, ME, USA

    Sydney Springer

  4. Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA

    Carolyn T. Thorpe

  5. Library System, University of Pittsburgh Health Sciences, Pittsburgh, PA, USA

    Michele Klein-Fedyshin

  6. School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA

    Steven M. Handler

Authors
  1. Jennifer A. Pruskowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sydney Springer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Carolyn T. Thorpe
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Michele Klein-Fedyshin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Steven M. Handler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jennifer A. Pruskowski.

Ethics declarations

Conflict of interest

Jennifer A. Pruskowski, Carolyn T. Thorpe, Michele Klein-Fedyshin, and Steven M. Handler declare that they have no conflicts of interest. Sydney Springer’s work on this project was supported by the Department of Veterans Affairs, Office of Academic Affairs Fellowship in Medicare Safety & Pharmacy Outcomes. The views expressed are those of the authors and do not represent the views of the Department of Veterans Affairs.

Funding

The authors received no funding support for this work or to assist in the preparation of this article.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Pruskowski, J.A., Springer, S., Thorpe, C.T. et al. Does Deprescribing Improve Quality of Life? A Systematic Review of the Literature. Drugs Aging 36, 1097–1110 (2019). https://doi.org/10.1007/s40266-019-00717-1

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-019-00717-1

Search

Navigation