Unnecessary medication use in frail older adults can be reduced through team-based care, providing education to providers and reviewing prescribing practices

Tjia J, Velten SJ, Parsons C et al. Studies to reduce unnecessary medication use in frail older adults: A systematic review Drugs Aging. 2013;30(5):285-307.

Review question

How can unnecessary medication use among frail older adults and those near end of life be identified and reduced?

Background

Unnecessary medications are those that:

• should not have been prescribed due to lack of benefit;
• are used in excessive dose or for too long; and
• cause harmful side effects.

It has been estimated that 40-50% of frail older adults or those with limited life expectancy use unnecessary medications. At this stage of life, harmful side effects have the potential to contribute to patient decline and premature death.

How the review was done

The review aimed to identify studies conducted between 1966 and 2012 that evaluated interventions to discontinue unnecessary medications taken on a daily basis for chronic conditions.

36 studies were included in the review, and included residents of nursing homes and assisted living facilities, hospitalized patients, hospice/palliative care patients, home care patients, and frail or disabled community-dwelling patients.

Funding was provided by the American Federation for Aging Research; School of Pharmacy, Queen’s University Belfast; and the National Institute of Aging (U.S.)

What the researchers found

The majority of studies used the judgment of clinicians to identify unnecessary medication use.

Interventions that were identified to reduce medication use and which could be suggested for healthcare staff to use, include:

• pharmacists leading medication reviews,
• pharmacists working with interdisciplinary teams,
• outreach or education for prescribers,
• assessing prescribing practices and providing feedback about the results to prescribers, and
• physicians leading medication reviews.

Study findings for pharmacist-led medication reviews were inconsistent.

The majority of studies that assessed pharmacists working with interdisciplinary teams found a decrease in unnecessary medication use.

All of the studies evaluating outreach and education for prescribers, assessments of prescribing practices and physician-led medication reviews found a decrease in unnecessary medication use.

Conclusion

The most beneficial interventions to suggest to healthcare staff to help manage patient medications are pharmacists working with interdisciplinary teams, outreach and education for prescribers, assessments of prescribing practices and physician-led medication reviews.

This review was determined to be of medium methodological quality based on an assessment using the AMSTAR tool.