DEPRESCRIBING PREVENTIVE MEDICATIONS IN OLDER ADULTS WITH ADVANCED FRAILTY, DEMENTIA, OR LIMITED LIFE EXPECTANCY: A SYSTEMATIC REVIEW AND META-ANALYSIS
Author(s)
sanskriti shukla, BSc, MSc1, Saibal Das, MBBS, MD, DM2, vrushaali shendaage, BDS3, cecilia lundborg, PHD4;
1Translational Health Science and Technology Institute, Faridabad, India, 2Indian Council of Medical Research - National Institute for Research in Bacterial Infections, Kolkata, India, 3Umeå Universitet, Umeå, Sweden, 4Karolinska Institutet, stockholm, Sweden
1Translational Health Science and Technology Institute, Faridabad, India, 2Indian Council of Medical Research - National Institute for Research in Bacterial Infections, Kolkata, India, 3Umeå Universitet, Umeå, Sweden, 4Karolinska Institutet, stockholm, Sweden
OBJECTIVES: This study was performed to evaluate the effect of deprescribing preventive medications (antihypertensives, statins, and antidiabetics) compared to continuation on clinical, functional, and patient-centered outcomes among older adults with advanced frailty, dementia, or limited life expectancy.
METHODS: A systematic review and meta-analysis was performed according to the 2020 PRISMA guidelines (PROSPERO ID: CRD420251147086). Medline (Ovid), Embase, Cochrane Library, Web of Science, CINAHL and ProQuest Dissertations & Theses Global were searched without date or language restrictions for eligible randomized controlled trials and observational studies. The primary outcome was all-cause mortality. Secondary outcomes were hospitalization, major adverse cardiovascular events (MACE), changes in blood pressure, and quality of life. Data were pooled (risk ratio [RR] or mean difference or standardized mean difference) using random-effects models (RevMan version 5.4). The certainty of evidence was evaluated by the GRADE framework.
RESULTS: From 10,397 records, 15 studies (>33,000 participants) were included. Overall, deprescribing was not associated with increased risk of all-cause mortality (RR: 1.15, 95% CI: 0.98-1.35, I2: 93%), hospitalization (RR: 0.93, 95% CI: 0.82-1.07, I2: 68%), or MACE (RR: 1.37, 95% CI: 0.70-2.70, I2: 95%) (certainty: very low GRADE). Deprescribing was also not associated with increased risks of fracture, fall, or deterioration of quality of life, but with slightly increased systolic blood pressure (deprescribing antihypertensives).
CONCLUSIONS: Deprescribing preventive medications in frail or palliative older adults does not worsen clinical, functional, or patient-centered outcomes. Implementation of deprescribing strategies should be prioritized in this population, supported by further real-world studies.
METHODS: A systematic review and meta-analysis was performed according to the 2020 PRISMA guidelines (PROSPERO ID: CRD420251147086). Medline (Ovid), Embase, Cochrane Library, Web of Science, CINAHL and ProQuest Dissertations & Theses Global were searched without date or language restrictions for eligible randomized controlled trials and observational studies. The primary outcome was all-cause mortality. Secondary outcomes were hospitalization, major adverse cardiovascular events (MACE), changes in blood pressure, and quality of life. Data were pooled (risk ratio [RR] or mean difference or standardized mean difference) using random-effects models (RevMan version 5.4). The certainty of evidence was evaluated by the GRADE framework.
RESULTS: From 10,397 records, 15 studies (>33,000 participants) were included. Overall, deprescribing was not associated with increased risk of all-cause mortality (RR: 1.15, 95% CI: 0.98-1.35, I2: 93%), hospitalization (RR: 0.93, 95% CI: 0.82-1.07, I2: 68%), or MACE (RR: 1.37, 95% CI: 0.70-2.70, I2: 95%) (certainty: very low GRADE). Deprescribing was also not associated with increased risks of fracture, fall, or deterioration of quality of life, but with slightly increased systolic blood pressure (deprescribing antihypertensives).
CONCLUSIONS: Deprescribing preventive medications in frail or palliative older adults does not worsen clinical, functional, or patient-centered outcomes. Implementation of deprescribing strategies should be prioritized in this population, supported by further real-world studies.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
HSD77
Topic
Health Service Delivery & Process of Care
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Diabetes/Endocrine/Metabolic Disorders (including obesity), SDC: Geriatrics