Recommendations

Pharmaceutical Society of Australia

4.

Do not prescribe medications for patients on five or more medications, or continue medications indefinitely, without a comprehensive review of their existing medications, including over-the-counter medications and dietary supplements, to determine whether any of the medications or supplements should or can be reduced or discontinued.

The use of medications for older people can improve symptom control and reduce disease progression. However, the use of five or more medications is independently associated with poor clinical outcomes including increased hospital admissions, falls and premature mortality. Deprescribing (which is the process of discontinuing or reducing medications) is an intervention to improve the quality use of medicines. Deprescribing is an intervention to manage polypharmacy that requires balancing the potential benefit and harm of each medication then systematically withdrawing medications that are no longer needed or clinically indicated or are inappropriate for that individual at that time. There is a growing body of evidence to support deprescribing in older people.

Supporting evidence
  • Martin P, Tamblyn R, Benedetti A, et al. Effect of a pharmacist-led education intervention on inappropriate medication prescriptions in older adults: the D-PRESCRIBE randomised clinical trial. JAMA 2018; 320(18):1889-1898
  • Page A, Potter K, Clifford R, et al. Deprescribing in older people. Maturitas. 2016;91:115-134. doi: 10.1016/j.maturitas.2016.06.006
  • Potter K, Flicker L, Page A, et al. Deprescribing in frail older people: a randomised controlled trial. PLoS one. 2016;11(3):e0149984. doi: 10.1371/journal.pone.0149984
  • Page AT, Clifford RM, Potter K, et al. The feasibility and the effect of deprescribing in older adults on mortality and health: A systematic review. Br J Clin Pharmacol. 2016;82(3):583-623. doi: 10.1111/bcp.12975
  • Page AT, Clifford R, Potter K, et al. A concept analysis of deprescribing medications in older people. Journal of Pharmacy Practice and Research. 2018;48(2):132-148 doi:10.1002/jppr.1361
  • Potter K, Page A, Clifford R, et al. Deprescribing: A guide for medication reviews. Journal of Pharmacy Practice and Research. 2016;46(4): 358–367 doi:10.1002/jppr.1298
  • Scott IA, Anderson K, Freeman CR, et al. First do no harm: a real need to deprescribe in older patients. Med J Aust 2014;201(7):390-2.
  • Reeve E, Thompson W, Farrell B. Deprescribing: A narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European Journal of Internal Medicine. 2017 Mar 1;39 (supplement): 3-11
How this list was made How this list was made

A working party of members of the Pharmaceutical Society of Australia (PSA) was established. Members of the State and Territory Branch Committees were invited to contribute suggested recommendations. Over 40 recommendations were submitted. The working party grouped the recommendations into themes, eliminated ones that were out of scope, reduced the list to twelve and refined the wording. All PSA members were sent an online survey to rank the proposed recommendations, indicate how likely they would be to implement the recommendations in practice, and suggest additional items for consideration.

Based on the survey responses, six recommendations were shortlisted and supporting evidence gathered. The final list was signed off by the PSA Board in November 2018.

Note: PSA uses Vancouver reference style. Where there are more than three authors, only the first three are listed followed by et al.