A deprescribing intervention for hospitalized older adults reduces polypharmacy (Shed-MEDS)

Clinical Question

For older adults, does a deprescribing intervention at a hospital and post-acute care facility decrease the medication burden?

Bottom line

An extensive deprescribing intervention led by a pharmacist or a nurse practitioner and targeted older adults discharged from the hospital to a PAC facility leads to a decrease in the overall medication burden without an increase in adverse events. (LOE = 1b)

Overuse alert: This POEM aligns with the Canadian Geriatrics Society’s Choosing Wisely Canada recommendation: Don’t prescribe a medication without conducting a medication reconciliation review, and consider opportunities for deprescribing at interfaces of care.

Study design: Randomized controlled trial (nonblinded)

Funding: Government

Setting: Inpatient (any location) with outpatient follow-up

Reviewer

Nita Shrikant Kulkarni, MD
Assistant Professor in Hospital Medicine
Northwestern University
Chicago, IL


Discuss this POEM


Comments

Arup Kumar Dhara

Impact assessment

Excellent

Anonymous

Seniors and deprescribing

Justifies what we have endeavoured to do for decades

Robert Dale Nicoll

Polypharmacy in LTC and in our lives.

Excellent POEM. Now we have to ensure all LTC providers are informed.

Anonymous

Presumption is dangerous

I have pts suffer horribly from hospital initiation of psych med termination especially benzodiazepines

Anonymous

A deprescribing intervention for hospitalized older adults r

the study doesnt appear to say how long the patients were followed up for. Also, it seems that most of the 'meds' deprescribed were vitamins and laxatives, deprescribed by pharmacists and nurse practitioners who had no responsibility for the long term consequences of the deprescribing. Hence, the overall impression is of a superficial 'feel good' study designed to make pharmacists feel good about themselves for a short term intervention, without seriously considering any long term clinical effects on the patients.

Anonymous

reducing meds

deprescribing post hospital no increase in adverse events