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

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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.

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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

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  1. Jennifer A. Pruskowski
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  2. Sydney Springer
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  5. Steven M. Handler
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Correspondence to Jennifer A. Pruskowski.

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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.

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

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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

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