Deprescribing in Australian residential aged care facilities: A scoping review

Objectives

Older adults residing in residential aged care facilities (RACFs) are particularly vulnerable to negative health outcomes from polypharmacy and suboptimal prescribing in the context of frailty and multimorbidity. Deprescribing, the intentional withdrawal of inappropriate medications, has been proposed as a promising approach to reduce polypharmacy-related harms. Examining current deprescribing interventions in RACFs would help identify gaps in research knowledge. The aim of this scoping review was to synthesise the current literature, describe the current knowledge gaps and future research priorities that the authors identified.

Methods

MEDLINE, Embase, CINAHL, PsycINFO and AgeLine were searched according to the Joanna Briggs Institute (JBI) guidelines for scoping reviews from inception until February 2024 to identify relevant studies published in the English language.

Results

Of the 2244 articles screened, 13 studies (total of 133,150 RACF residents across Australia) were identified examining deprescribing interventions. Six studies were controlled trials and seven studies were observational studies. There were six pharmacist-led interventions, five multidisciplinary team-led interventions and two physician-led interventions. Main themes discussed included as follows: multidisciplinary care, education for health-care professionals, refining outcome measures, overcoming system issues and research logistics. The most commonly targeted medications in the included studies were psychotropics.

Conclusions

Deprescribing is an important intervention for RACF residents but more research into translating evidence into clinically meaningful outcomes is needed. Successful studies typically involved multidisciplinary interventions, had an educational component, followed-up longitudinally with residents and carers and involved stakeholders, such as nurses. The economic impacts of deprescribing in this cohort are poorly understood.