Deprescribing Proves Effective: New Evidence Shows Frailty Reversal In Older Adults GlobalRPH

Deprescribing Proves Effective New Evidence Shows Frailty Reversal in Older Adults

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Introduction

Deprescribing offers a promising solution to the growing challenge of medication burden in older adults. One-third of people aged over 65 years live with multimorbidity and take five or more regular medicines, with this number increasing to 50% in those over 85 years old. This widespread polypharmacy carries substantial risks rather than benefits, particularly among frail elderly populations. Recent research has revealed that polypharmacy in older people is associated with increased risk of serious adverse events, falls, cognitive impairment, functional decline, hospitalization, and even death.

For the first time, researchers have discovered that multiple medications increase frailty and impair function in old age. However, the relationship between medications and adverse outcomes appears more nuanced than previously understood. Notably, it is not merely the number of drugs but rather their type and dosage that primarily contribute to negative health consequences. Most importantly, these adverse effects on frailty and function diminish after medication discontinuation. The deprescribing process involves systematically identifying and discontinuing medications when existing or potential harms outweigh the benefits, within the context of the individual patient’s goals and current level of care. Although more than 15 million Americans aged 65 years and older are prescribed five or more medications, studies indicate that deprescribing interventions have high feasibility, with 72-91% of recommendations successfully implemented.

This article examines emerging evidence supporting deprescribing as an effective intervention to reverse frailty in older adults. Based on recent studies, deprescribing has shown positive impacts on clinical outcomes, including depression, mental health status, function, and frailty itself. Additionally, research demonstrates that deprescribing polypharmacy can be achieved with potentially important benefits, especially when patient-specific interventions are applied early in the “young old” population (aged 65-79). Throughout this review, we will explore the bidirectional relationship between medication use and frailty, practical deprescribing guidelines, and the documented outcomes that make this approach increasingly valuable in geriatric care.

Understanding Frailty and Polypharmacy in Older Adults

Frailty and polypharmacy represent interconnected challenges that significantly affect the health outcomes of older adults. While they often coexist, understanding their individual characteristics and relationship provides crucial context for effective medication management and deprescribing strategies.

Frailty as a Geriatric Syndrome

Frailty is a clinically recognizable syndrome characterized by decreased physiological reserve and increased vulnerability to stressors. This state of physiological decline extends across multiple organ systems, diminishing an older adult’s ability to maintain homeostasis in the face of acute illness or other challenges. The prevalence of frailty increases substantially with age, affecting approximately 4.1% of Europeans aged 50-64 years and rising to 17.0% in those aged ≥65 years [1]. According to systematic reviews, the overall prevalence ranges from 4% to 59% depending on the assessment method and population studied [2].

The most widely used framework for identifying frailty is Fried’s phenotype, which defines frailty as meeting three or more of these criteria:

Unintentional weight loss
Self-reported exhaustion
Weakness (measured by grip strength)
Slow walking speed
Low physical activity

Individuals meeting one or two criteria are classified as “pre-frail,” while those with none are “non-frail” [2]. Moreover, frailty should be distinguished from disability (impairment in activities of daily living) and comorbidity (presence of multiple chronic conditions), though these conditions frequently overlap [2]. At the population level, frail individuals face substantially higher risks of adverse outcomes, including falls, hospitalization, institutionalization, and mortality [1].

Polypharmacy Prevalence in the 65+ population

Polypharmacy—commonly defined as the concurrent use of five or more medications—has reached concerning levels among older adults globally. Across European countries, the prevalence of polypharmacy in community-dwelling adults aged 65 and older ranges from 26.3% to 39.9%, with an overall rate of 32.1% [3]. Furthermore, the prevalence increases with advancing age: 25.3% for those aged 65-74 years, 36.4% for those aged 75-84 years, and 46.5% for those aged 85 years and older [3].

The trend of increasing medication use is striking. In Ireland, polypharmacy rates among older adults rose from 17.8% in 1997 to 60.4% in 2012, while excessive polypharmacy (≥10 medications) increased from 1.5% to 21.9% during the same period [3]. In the United States, heart disease patients exhibited the highest prevalence, increasing from 40.6% to 61.7% between 1999-2000 and 2017-2018, followed by diabetes patients at 57.7% [3]. Among frail older adults specifically, the prevalence of polypharmacy reaches 59%, with 22% experiencing hyper-polypharmacy [3].

Bi-directional Relationship Between Frailty and Medication Use

Recent research has established a complex, bidirectional relationship between frailty and medication use. A meta-analysis revealed that 75% of adults with polypharmacy are either pre-frail or frail [3], while longitudinal studies indicate that taking seven or more medications is associated with a 2.5-fold increased risk of developing frailty over eight years [3]. This relationship persists even after controlling for the number of chronic conditions [4].

The mechanisms connecting these conditions work in both directions. Frailty predisposes older adults to medication-related problems through age-associated changes in pharmacokinetics and pharmacodynamics. Frail individuals have compromised homeostatic mechanisms and attenuated physiological reserve across cardiovascular, respiratory, renal, and central nervous systems, making them more susceptible to adverse drug reactions [4].

Conversely, polypharmacy may accelerate frailty through several pathways. Many clinical indicators of frailty—including weight loss, balance difficulties, and functional decline—have been directly linked to medication burden [4]. A longitudinal study demonstrated this bi-directional relationship, with a stronger effect observed from frailty to medication-related problems than the reverse pathway (p < 0.05) [1].

This interrelationship creates a concerning cycle: frailty increases vulnerability to medication-related harm, while polypharmacy potentially worsens frailty. Hence, medication deprescribing becomes a critical intervention point in this cycle, offering an opportunity to reduce medication burden and potentially reverse frailty progression in vulnerable older adults.

Defining Deprescribing and Its Clinical Relevance

The systematic approach to medication discontinuation has emerged as a central concern in geriatric medicine, driven by recognition of medication-related harm as a common geriatric syndrome. As healthcare systems grapple with aging populations and increasing medication burden, structured approaches to reducing inappropriate pharmaceuticals have become essential components of care planning.

Deprescribing Meaning in Geriatric Care

Deprescribing constitutes “the systematic process of identifying and discontinuing drugs in instances where existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences” [5]. The term first appeared in medical search engines between 2016 and 2020, marking its relatively recent emergence as a formal concept [5]. Unlike traditional reactive approaches to medication management—where drugs are stopped only after problems occur—deprescribing represents a proactive, preventative strategy.

The process fundamentally differs from simply stopping medications; it involves tapering, reducing doses, or withdrawing drugs under qualified healthcare professional supervision [6]. Central to effective deprescribing is active patient and caregiver engagement, which enhances adherence and intervention effectiveness [6]. The deprescribing process typically aims to reduce harm from side effects, decrease pill burden, and eliminate medications with minimal or unrealized benefit [5].

Deprescribing Guidelines: STOPP, STOPPFrail, Beers Criteria

Several evidence-based tools support clinicians in identifying medications appropriate for deprescribing. These tools can be classified as either Drug-Oriented Listing Approaches (DOLAs) or Patient-In-Focus Listing Approaches (PILAs), with the latter requiring knowledge of specific patient characteristics [2].

The Beers Criteria, updated most recently in May 2023, represents one of the oldest and most established guidelines, first released in 1991 [3]. Developed by the American Geriatrics Society, these criteria identify medications best avoided by older adults in most circumstances or in specific situations [3].

The STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria work in tandem to identify which medications should be discontinued or initiated [7]. The latest version (Version 3, 2023) expanded cardiovascular system criteria by 61.5% and coagulation system criteria by 23.1% compared to previous versions [3].

For frail older adults with limited life expectancy, STOPPFrail provides 27 explicit criteria for potentially inappropriate medications [3]. Designed specifically for this vulnerable population, it serves as an efficient tool for structured deprescribing in patients with poor prognosis [3].

Despite the proliferation of these tools—a recent review identified over 70 drug lists [2]—research indicates that PILAs, such as FORTA and STOPP/START, are more beneficial to patients than DOLAs in randomized controlled trials [2].

Prescription Overload: Deprescribing vs Optimization

The distinction between deprescribing and medication optimization represents an important conceptual difference in approach. While deprescribing focuses primarily on discontinuation, optimization encompasses a broader range of interventions, including dose adjustments and medication substitutions to achieve optimal therapeutic outcomes [7].

The Lown Institute has identified medication overload as a significant threat to healthcare systems, with nearly 20% of older adults taking 10 or more medications daily [3]. The United States alone is projected to spend $62 billion on hospitalizations due to adverse drug events over the next decade [3].

Deprescribing interventions range from clinical pharmacist medication reviews to direct patient educational materials [8]. These strategies have demonstrated modest but meaningful results—a meta-analysis found deprescribing reduced medication counts (mean difference -0.14, 95% CI -0.27 to -0.01) [6]. Though individually small, these effects may produce substantial population-level benefits given the prevalence of polypharmacy [6].

Consequently, many countries have developed national implicit guidelines for managing polypharmacy and deprescribing [2]. In contrast to reactive approaches that address problems after they occur, successful deprescribing strategies adopt systematic, proactive approaches to medication review [5]. Ultimately, the goal extends beyond merely reducing medication counts to improving patient outcomes through the thoughtful analysis of benefit-risk profiles in the context of individual patient circumstances and preferences.

Study Designs Evaluating Deprescribing Outcomes

Research examining deprescribing interventions has expanded substantially in recent years, with a scoping review identifying 125 papers reflecting 107 distinct studies [9]. These investigations employ diverse methodologies and parameters to evaluate outcomes of medication discontinuation, particularly in frail older populations.

Inclusion Criteria: Frailty Measures and Age Thresholds

Most deprescribing studies establish clear inclusion parameters centered on age and frailty status. First and foremost, the age threshold is typically set at 65 years, with participants often stratified into subgroups (65-74, 75-84, and 85+) to account for age-related differences in medication response [1]. To identify frailty accurately, researchers employ validated assessment tools, including:

Fried Frailty Phenotype
FRAIL scale
PRISMA-7
Electronic Frailty Index
Edmonton Frail Scale
Clinical Frailty Scale (CFS)

Many studies require at least 50% of the study population to be identified as frail using these measures [4]. In essence, these selection criteria ensure homogeneity in study populations while allowing for meaningful evaluation of deprescribing outcomes. Some investigations further refine their populations by excluding moribund, terminal, or palliative participants to focus on preventative rather than end-of-life care [1].

Types of Interventions: Pharmacist-led vs MDT-led

Deprescribing interventions generally fall into two primary categories: pharmacist-led and multidisciplinary team (MDT)-led approaches. Pharmacist-led interventions leverage specialized medication knowledge, with three studies reporting good-quality scores (>6/9) across care home, primary care, and hospital settings [4]. Subsequently, these interventions demonstrated typical median reductions ranging from one to three medicines per patient [10].

In contrast, MDT-led approaches involve professionals from two or more disciplines working collaboratively. A review identified that when pharmacists are well-integrated into primary care teams and lead medication reviews—with general practitioners (GPs) and other healthcare professionals involved as needed—communication and decision-making improved [11]. As a result, implementation rates for deprescribing recommendations ranged from 72% to 91%, demonstrating considerable effectiveness [10].

Both intervention types frequently utilize established criteria to guide medication discontinuation decisions. The STOPP, Beers, and STOPPFrail criteria serve as common frameworks, with studies showing that STOPP/START criteria offer greater clinical benefit than drug-oriented listing approaches [12].

Settings: Hospital, Community, Care Homes

Deprescribing studies occur across diverse healthcare environments, each presenting unique considerations. Hospital-based interventions often take advantage of admission to initiate deprescribing [10]. Under those circumstances, research physicians or inpatient geriatric teams implement interventions pre-discharge, with follow-up periods typically ranging from 3-12 months [4].

Community settings present different challenges, with more than 90% of older adults living independently [13]. To put it differently, adults in the community generally have greater autonomy in medication management, which makes intervention implementation more complex. Nevertheless, deprescribing in this context has shown moderate-certainty evidence for reduced potentially inappropriate medications (PIMs) and medication counts [13].

Care homes offer structured environments where medication administration is closely supervised. In these settings, one longitudinal prospective study demonstrated that a geriatric consultant collaborating with general practitioners could successfully implement algorithm-based deprescribing [4]. Together with other care home studies, research indicates that deprescribing can reduce PIMs compared to standard care, albeit with very low certainty of evidence [14].

The setting influences multiple aspects of study design, from medication assessment methods to appropriate follow-up timeframes [9]. For instance, institutional settings allow for direct observation of medication lists, while community studies often rely on electronic health records, pharmacy dispensing data, or billing claims [9].

Safety Outcomes of Deprescribing in Frail Populations

Safety concerns frequently emerge in clinical discussions about deprescribing practices. A careful examination of recent evidence reveals important insights into the potential risks and benefits of reducing medication burden in frail older adults.

Adverse Drug Withdrawal Events (ADWEs)

ADWEs encompass any clinically meaningful symptoms arising from medication cessation or dose reduction, including physiological withdrawal reactions or recurrence of underlying medical conditions. Recent studies indicate that ADWEs occur less commonly than adverse drug reactions in older adults, yet still warrant careful consideration [15]. In one retrospective study examining 175 nursing home residents, 94 ADWEs were documented among 62 individuals over 18 months—approximately one ADWE for every two discontinued medications [15]. Likewise, a one-year health service intervention study found that roughly 26% of older adult outpatients experienced at least one ADWE, amounting to 1 event per 3.3 medications stopped [15].

The severity of these events varies considerably. A pilot study identified a concerning trend: approximately one-third of deprescribing events led to a likely or possible ADWE within 3 months, with 80% of those contributing to hospital readmission [15]. Cardiac medications, particularly diuretics, were implicated in four out of six ADWEs assessed as likely contributing to readmission [15].

Detection methods for ADWEs remain inconsistently applied across clinical trials. A review of 139 deprescribing studies found that merely 8.6% specifically reported ADWEs as an outcome [16]. Across 12 studies that monitored for ADWEs, 3,037 events were detected among 12,223 participants, with rates ranging from zero to 1.25 ADWEs per enrolled patient [16]. This substantial variability suggests potential underreporting or methodological inconsistencies in ADWE identification.

For certain medications, tapering protocols can minimize withdrawal risks. For example, antihypertensive medications typically benefit from a 3-6 week taper, while corticosteroids may require weekly 5mg reductions until reaching 6-11mg daily [8]. In the case of proton pump inhibitors, evidence indicates that careful discontinuation remains challenging—one study of 98 chronic PPI users (median age 63) found only 27% successfully remained off PPIs for a year post-discontinuation [8].

Hospitalization and Mortality Rates Post-Deprescribing

Contrary to fears about increased risk, multiple studies demonstrate that properly implemented deprescribing does not raise hospitalization or mortality rates. Two multidisciplinary team-led deprescribing interventions in hospital and community settings showed no substantial differences in unplanned hospitalizations and mortality compared to control groups [3]. Specifically, one randomized controlled trial reported no statistically significant differences for three-month unscheduled hospital presentations (0.14 intervention vs. 0.08 control, P = 0.27) or mortality (0.18 vs. 0.28, P = 0.22) [3].

Similarly, a longitudinal cohort study in community settings found comparable hospitalization rates per patient per year (0.39 in the intervention vs. 1.02 in the comparator group, p = 0.1006) and survival rates (77% in the intervention vs. 67% in the comparator group, p = 0.026) after 3 years [3]. Interestingly, this study also reported that the number of significant complications per patient/year was markedly reduced in the intervention group (0.22 in the intervention vs. 1.72 in the comparator group, p = 0.0047) [3].

Meta-analyses provide further reassurance regarding mortality outcomes. A review concluded that deprescribing polypharmacy did not result in a substantial reduction in mortality in either randomized (OR 0.96, 95% CI 0.84–1.09) or non-randomized studies (OR 0.70, 95% CI 0.36–1.38) [1]. Nevertheless, important subgroup findings emerged—mortality was significantly reduced when patient-specific deprescribing interventions were applied (OR 0.79, 95% CI 0.63–0.99) and among younger older adults aged 65-79 (OR 0.71, 95% CI 0.51–0.99) [1].

Clinical Outcomes: Frailty Reversal and Functional Gains

Evidence from multiple trials reveals that medication reduction yields measurable improvements in clinical outcomes for frail older adults. Recent studies document not only changes in medication counts but also meaningful enhancements in health status and function following deprescribing interventions.

Frailty Score Improvements (e.g., Edmonton Frailty Scale)

Pharmacist-led deprescribing interventions have been shown to improve frailty measures. In one notable study focusing on the reduction of sedative and anticholinergic medications among 46 care home residents, researchers observed a mean decrease of 1.35 points on the Edmonton Frailty Scale after 6 months (95% CI, P < 0.05) [3]. This scale evaluates frailty across multiple domains, including cognition, general health status, functional independence, social support, medication use, nutrition, mood, continence, and functional performance. Indeed, each point reduction represents meaningful clinical improvement in physiological reserve.

Beyond direct measurements, another pharmacist-led study established a positive correlation between potentially inappropriate medications (PIMs) and frailty status. Researchers identified a statistically meaningful association (r = 0.280, P = .040) between PIM counts (using STOPP and Beers criteria) and electronic Frailty Index scores [3]. This correlation underscores the potential for deprescribing to modify frailty status through the reduction of harmful medication burden.

Functional Status and Daily Living Metrics

Functional outcomes show equally promising results following deprescribing interventions. One multidisciplinary team-led study evaluated functional status using a 5-point scale (ranging from independent to severely disabled). Patients in the poly-deprescribing group demonstrated substantially less functional deterioration than the control group—69.1% versus 34.4%, respectively (P < 0.001) [3].

In long-term care settings, researchers explored the impact of antihypertensive deprescribing on activities of daily living (ADL). Initially, ADL scores worsened by an average of 0.29 points (95% CI = 0.27, 0.31) every three months across the entire study population [17]. Primarily in non-dementia subgroups, deprescribing showed particular benefit—residents who discontinued antihypertensives experienced slight functional improvement over time, while continued users showed ADL decline (difference between groups -0.23 points every three months, 95% CI = -0.43, -0.03) [17].

Cognitive functional metrics also improved following deprescribing. A research study using a target trial emulation approach among 12,644 nursing home residents found that antihypertensive deprescribing was associated with less cognitive decline [2]. In fully adjusted per-protocol analysis, residents in the deprescribing group experienced a 12% reduction in odds of progressing to worse cognitive function categories per 12-week period (OR 0.88; 95% CI, 0.78-0.99; P = .04) [2]. This protective association proved especially pronounced among residents with dementia, who showed 16% reduced odds of cognitive function worsening (OR 0.84; 95% CI, 0.72-0.98) [2].

Depression and Mental Health Improvements

Mental health outcomes demonstrate some of the most striking gains after deprescribing. Following pharmacist-led antipsychotic medication reduction in care homes, residents showed substantial improvement in depression scores using the Geriatric Depression Scale (mean difference of -2, p < 0.05) after six months [3]. Essentially, these changes occurred without negative impact on cognitive performance as measured by the interRAI cognitive performance scale (mean difference of 0, p = 0.26) [3].

Another multidisciplinary-led deprescribing study reported marked improvements in mental status as measured by the Mini-Mental State Examination. The intervention group showed dramatically better results than the control group (63 versus 3 participants showing improvement, p < 0.0001) [3]. Correspondingly, cognitive status also improved (7 in the intervention versus 0 in the control, P = 0.0004) [3]. For many participants, these improvements occurred within 3 months of deprescribing and persisted for two or more years in 68% of cases [3].

Medication-Related Outcomes and PIM Reduction

Deprescribing initiatives yield measurable reductions in medication burden, with recent studies documenting specific changes in pharmaceutical regimens among older adults. These changes extend beyond simple pill counts to include qualitative improvements in medication appropriateness and sustainability.

Reduction in Total Medications per Patient

Systematic reviews confirm that deprescribing interventions effectively reduce overall medication counts. Meta-analyses demonstrate a small but consistent decrease in the number of medications prescribed (SMD, −0.25 [95% CI, −0.38 to −0.13]), equivalent to approximately 0.5 fewer medications per patient [7]. Though modest at the individual level, this reduction creates substantial population-level benefits given polypharmacy’s prevalence. Moreover, more intensive interventions show greater impact—four studies reporting specific deprescribing targets achieved reductions ranging from 2-3 medicines per patient [3]. In home settings where poly-deprescribing of three or more drugs was implemented, participants experienced elimination of up to 7 medications per person [3]. For every nine (9) patients admitted during periods when intervention bundles plus stewardship programs were available to clinicians, one additional patient had one or more sedative or anticholinergic medications stopped or dose-reduced compared with usual care [6].

Decrease in Drug Burden Index and PIMs

Beyond raw medication counts, deprescribing demonstrates meaningful impact on medication appropriateness. First and foremost, Drug Burden Index (DBI)—a measure of total anticholinergic and sedative medication exposure—decreased by 0.34 in care home residents six months after pharmacist-led interventions [3]. Meanwhile, the prevalence of potentially inappropriate medications (PIMs) has declined over time—from 49.6% in 2011 to 39.6% in 2019, representing a 20% relative decrease with an annual percentage change of -1.19% [5].

The effectiveness varies across drug classes. Targeted deprescribing efforts increased the proportion of patients with at least one DBI-contributing medication stopped or reduced from 29.9% during control periods to 43.1% during stewardship periods [6]. Specifically, opioid prescription discontinuations rose from 17.9% during control to 45.7% during stewardship (p = 0.04) [6]. Other medication classes showed varying susceptibility to deprescribing, ranging from 18.8% for dopaminergic agents to 55.0% for antipsychotics [6].

Sustained Medication Discontinuation Rates

After initial deprescribing, most medications remain discontinued. In fact, within care homes, medicines were re-prescribed in merely 15% of cases [3]. Similarly, hospital-based deprescribing shows durability: of 162 medications stopped, only 40 (25%) were restarted during admission or at discharge, with 81% remaining discontinued after 3 months [3]. Another study demonstrated that 40% of deprescribing changes made during initial randomized controlled trials were sustained one year later [18].

Certain medication classes show particularly high sustainability rates. Discontinuation success neared 100% for benzodiazepines and remained high for nitrates, furosemide, H2 blockers, and omeprazole [19]. Tellingly, length of stay positively correlated with sustained DBI reduction (adjusted odds ratio 1.06, 95% CI 1.03–1.09), suggesting longer observation periods facilitate more durable medication changes [6].

Feasibility and Acceptability of Deprescribing

Clinical implementation of deprescribing protocols has gained traction, with research demonstrating both practical feasibility and patient acceptance. Recent studies illuminate practical aspects of medication reduction initiatives across diverse healthcare environments.

Implementation Rates: 72–91% Acceptance

Across healthcare settings, deprescribing recommendations achieve remarkably high implementation rates. Multiple studies confirm that 72-91% of suggestions to deprescribe medications made by either pharmacists or multidisciplinary teams are successfully implemented [3]. In care homes, 82% of deprescribing recommendations were approved by general practitioners, with 96% receiving consent from residents or their families [3]. Likewise, hospital-based initiatives saw 72-81% of recommendations accepted and implemented by admitting physicians and patients [3]. Outpatient settings demonstrated even higher rates, with 91% of geriatrician recommendations accepted by community general practitioners [3].

Patient and Caregiver Satisfaction Metrics

Patient attitudes toward deprescribing reveal both willingness and satisfaction with medication reduction. Accordingly, 87.6% of patients express willingness to stop medications upon physician recommendation, though this drops to 74.8% among caregivers making decisions for others [4]. After pharmacist-led interventions, 87% of participants reported feeling comfortable with the recommended medication changes, with only 5% describing the experience as stressful and 11% as confusing [3]. Notwithstanding general satisfaction with current regimens (89% of patients and 79.2% of caregivers), most individuals remain open to medication reduction [4].

Barriers to Deprescribing in Clinical Practice

Several factors impede widespread adoption of deprescribing protocols. Chiefly, healthcare professionals report low to moderate confidence levels in deprescribing practices alongside concerns about potential negative outcomes [20]. Communication gaps between healthcare settings and differing opinions among clinicians often complicate implementation [21]. From the patient perspective, reluctance stems from dissatisfaction with medication (adjusted OR, 0.31; 95% CI, 0.21-0.47) and greater trust in general practitioners (adjusted OR, 0.960; 95% CI, 0.930-0.998) [22]. Common patient-reported barriers include perceived medication benefits (58%), belief that physicians only prescribe necessary medications (50%), and habitual long-term medication use (41%) [22]. Addressing these concerns straightaway through effective patient-practitioner communication represents a critical opportunity—patients who reported effective communication were more willing to accept deprescribing (OR = 4.56, 95% CI = 0.85–24.35) [23].

Cost Implications and Health System Impact

Beyond clinical efficacy, deprescribing interventions demonstrate considerable economic value across healthcare settings. As countries grapple with rising pharmaceutical costs, financial analyzes provide compelling support for medication reduction programs.

Medication Cost Savings per Patient

The direct financial impact of deprescribing varies by setting and intervention type. In long-term care facilities, deprescribing potentially inappropriate medications reduced average monthly medication costs from USD 874.00 to USD 843.00 (P < 0.0001) [24]. Notably, a pharmacist-led proton pump inhibitor deprescribing service saved USD 235 per patient [11]. First thing to remember, these savings accumulate across medication categories—scheduled medication costs declined from USD 814.00 to USD 801.00 (P = 0.007), while PRN medication expenses dropped from USD 60.00 to USD 42.00 (P < 0.0001) [24]. Within care homes, annual drug savings ranged from £78 to £ 89 per patient review [10].

Resource Allocation and Time Investment

Implementing deprescribing requires a modest investment of professional time. Pharmacists typically spent 34-35 minutes per patient review [11][25], whereas physicians needed merely 3±1.2 minutes to consider recommendations [25]. With attention to efficiency, the average intervention cost ranges from USD 239.13 per participant in residential aged care [26] to €391 (USD 459.00) per capita for comprehensive programs [27].

Economic Evaluation of Deprescribing Programs

All things considered, deprescribing programs demonstrate favorable economic profiles. One intervention generated a net benefit of € 85,909, with a cost-benefit ratio of 33.2 [25]. Another program delivered £148,656 in savings after accounting for pharmacist costs [10]. Cost avoidance per patient reached €619.6 [25]. To clarify current limitations, analysts recommend extending evaluation beyond the typical one-year timeframe to capture long-term benefits [28].

Conclusion

Deprescribing emerges as a powerful intervention for addressing the complex interplay between medication burden and frailty in older adults. Recent evidence demonstrates that carefully implemented medication reduction not only decreases pill counts but also reverses frailty indicators across multiple assessment tools. The Edmonton Frailty Scale, functional status metrics, and cognitive performance measures all show measurable improvements following successful deprescribing interventions. These benefits extend beyond physiological parameters to encompass enhanced mental health outcomes, with notable reductions in depression scores and improved cognitive functioning.

Though concerns about adverse drug withdrawal events persist, data reveal these occurrences remain less common than anticipated when proper protocols guide medication discontinuation. Contrary to traditional assumptions, properly executed deprescribing does not increase mortality or hospitalization rates. Patient-specific approaches yield particularly promising results, especially when applied to younger segments of the older adult population (65-79 years).

Feasibility data further strengthen the case for wider implementation of deprescribing programs. Healthcare professionals consistently achieve 72-91% acceptance rates for deprescribing recommendations across diverse settings. Patients themselves express high levels of satisfaction with medication reduction, despite initial hesitations. The economic case likewise proves compelling—deprescribing interventions generate substantial cost savings while requiring modest professional time investment.

Overall, the accumulated evidence paints a clear picture: deprescribing is an effective, safe, and cost-effective approach to managing medication burden in frail older adults. This approach aligns with patient-centered care principles while addressing the fundamental mechanisms underlying the link between polypharmacy and frailty. Healthcare systems must now prioritize widespread implementation of structured deprescribing protocols, especially considering their potential to interrupt the vicious cycle between medication burden and deteriorating health status in vulnerable elderly populations.

Deprescribing stands poised to transform geriatric care practices as practitioners recognize its role not merely in harm reduction but as an active intervention capable of restoring function and improving quality of life. Future research should focus on optimizing implementation strategies across diverse healthcare settings while continuing to document long-term outcomes of sustained medication reduction in this vulnerable population.

Key Takeaways

Recent research reveals that deprescribing—the systematic reduction of medications—can effectively reverse frailty in older adults while improving multiple health outcomes.

Deprescribing safely reverses frailty: Studies show 1.35-point improvements on the Edmonton Frailty Scale within 6 months, with 69% less functional deterioration compared to controls.
High implementation success rates: Healthcare professionals achieve 72-91% acceptance rates for deprescribing recommendations across hospital, community, and care home settings.
Medication reduction doesn’t increase mortality: Properly implemented deprescribing shows no increased hospitalization or death rates, with patient-specific approaches reducing mortality by 21%.
Mental health benefits are substantial: Participants experienced significant depression score improvements (-2 points) and better cognitive function after medication reduction.
Economic benefits are clear: Programs generate $235-619 savings per patient while requiring only 34-35 minutes of pharmacist time per review.

The evidence demonstrates that deprescribing breaks the harmful cycle between medication burden and frailty, offering a practical solution to improve health outcomes in vulnerable older adults while reducing healthcare costs.

Frequently Asked Questions:

FAQs

Q1. What is deprescribing, and how does it benefit older adults? Deprescribing is the systematic process of identifying and discontinuing medications when potential harms outweigh benefits. It can reverse frailty, improve mental health, and enhance functional status in older adults without increasing mortality or hospitalization rates.

Q2. How effective are deprescribing interventions in reducing medication burden? Deprescribing interventions are highly effective, with studies showing reductions of 0.5 to 3 medications per patient on average. Implementation rates for deprescribing recommendations range from 72% to 91% across various healthcare settings.

Q3. Are there any risks associated with deprescribing in frail older adults? While adverse drug withdrawal events can occur, they are less common than anticipated when proper protocols are followed. Studies show that carefully implemented deprescribing does not increase mortality or hospitalization rates in frail older populations.

Q4. How do patients and caregivers feel about deprescribing? Most patients (87.6%) are willing to stop medications upon physician recommendation. After pharmacist-led interventions, 87% of participants reported feeling comfortable with recommended medication changes, with only 5% describing the experience as stressful.

Q5. What are the economic benefits of deprescribing programs? Deprescribing programs demonstrate favorable economic profiles, with studies showing cost savings ranging from $235 to $619 per patient. One intervention generated a net benefit of €85,909, with a cost-benefit ratio of 33.2, highlighting the potential for significant reductions in healthcare costs.