Interventions to Reduce Polypharmacy in Hospitalized Older Adults: A Systematic Review

Abstract

Introduction: Polypharmacy is highly prevalent in hospitalized older adults and is associated with adverse drug events, falls, and delirium. This review synthesizes the evidence for interventions aimed at reducing inappropriate polypharmacy (deprescribing) in this setting.

Methods: We searched for RCTs of interventions designed to reduce the number of prescribed medications in hospitalized adults aged 65 and older. Interventions included pharmacist-led medication reviews, geriatrician consultations, and computerized decision support.

Results: The analysis of 18 RCTs showed that multicomponent interventions, particularly those involving a comprehensive medication review by a clinical pharmacist, were effective in reducing the number of inappropriate medications at hospital discharge. However, the impact on clinical outcomes like readmission rates was inconsistent.

Discussion: While interventions can successfully reduce medication counts, translating this into improved clinical outcomes is challenging. A patient-centered approach that considers the goals of care is essential for meaningful deprescribing.

Conclusion: Pharmacist-led medication reviews are effective at reducing inappropriate polypharmacy in hospitalized older adults.