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Effectiveness of Interventions to Deprescribe Inappropriate Proton Pump Inhibitors in Older Adults

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Abstract

Background

The use of proton pump inhibitors (PPIs) in older adults is high, often inappropriate, and may cause harm. Deprescribing is defined as the reduction, withdrawal, or discontinuation of inappropriate medication.

Objective

We conducted a systematic review to determine the effectiveness of interventions to deprescribe inappropriate PPIs in older adults.

Methods

We searched MEDLINE, PubMed, Embase, the Cochrane Library, ProQuest Dissertations and Theses Global, and Google from inception to January 2017 for randomized and non-randomized studies describing the outcomes of interventions to deprescribe inappropriate PPIs in older adults (mean or median age of ≥65 years). Where available, clinically relevant outcomes were also assessed.

Results

We included 21 articles in our review. Six studies demonstrated effective interventions, 11 were inconclusive, and four were ineffective. Effective interventions included a population-wide education and promotion strategy, academic detailing for general practitioners, and inpatient geriatrician-led deprescribing. Methodological issues limited the interpretation of several studies. Standardization in outcome reporting was lacking, and clinical outcome data were absent. A comparison of intervention effectiveness was not possible because of their heterogeneity, which precluded a meta-analysis.

Conclusion

The limited available evidence suggests that some strategies are more successful than others in effectively deprescribing inappropriate PPIs in older adults. However, whether PPI deprescribing translates into better clinical outcomes remains unclear.

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Acknowledgements

The authors acknowledge Raechel Damarell (Medical Librarian, Flinders University) for her assistance in the design of our search strategy.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, Rm 6D302, Flinders Medical Centre and Flinders University, Bedford Park, SA, 5042, Australia

    Tom D. Wilsdon, Tilenka R. J. Thynne & Arduino A. Mangoni

  2. Department of Pharmacy, Queen Elizabeth Hospital, Woodville, SA, Australia

    Ivanka Hendrix

  3. School of Nursing, University of Adelaide, Adelaide, SA, Australia

    Ivanka Hendrix

  4. Adelaide Geriatrics Training and Research with Aged Care (GTRAC), School of Medicine, University of Adelaide, Adelaide, SA, Australia

    Ivanka Hendrix

  5. National Health and Medical Research Council Centre of Research Excellence: Frailty Trans-Disciplinary Research to Achieve Healthy Ageing, Adelaide, Australia

    Ivanka Hendrix

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  1. Tom D. Wilsdon
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  4. Arduino A. Mangoni
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Correspondence to Tom D. Wilsdon.

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TW, IH, TT, and AM have no conflicts of interest in relation to this manuscript.

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The original version of this article was revised: Author affiliation was incorrectly published in the original version and it has been updated.

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Wilsdon, T.D., Hendrix, I., Thynne, T.R.J. et al. Effectiveness of Interventions to Deprescribe Inappropriate Proton Pump Inhibitors in Older Adults. Drugs Aging 34, 265–287 (2017). https://doi.org/10.1007/s40266-017-0442-1

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