Authors (including presenting author) :
Leung LL (1)(2), Shum CK (1)(2), Kwan YK (1)(2), Ng MF (1)(2)
Affiliation :
(1) Division of Geriatrics, Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
(2) Primary and Community Health Care, New Territories West Cluster, Hong Kong
Introduction :
Older people living in Residential Care Homes for the Elderly (RCHEs) approaching End-of-Life (EOL) are commonly prescribed with medications that may no longer be beneficial, when the goals of care have shifted to symptomatic control and maintaining quality of life.
Deprescribing is a planned and supervised process of medication reduction, with goals of managing polypharmacy and improving outcomes.
As a quality improvement project, a 6-month deprescribing program was incorporated into the usual EOL care program of the Community Geriatric Assessment Team, New Territories West Cluster from 1 November 2020 to 30 April 2021.
Objectives :
Our study aimed to review the outcomes of the pilot deprescribing program.
Methodology :
In this retrospective cohort study, RCHE residents approaching EOL recruited into the Geriatrician-led deprescribing program were included as deprescribing group and compared with a historical control. For participants in deprescribing group, medication review would be conducted by a panel of Geriatricians with reference to STOPPFrail Criteria Version 2. Deprescribing recommendations would be discussed with participants or their next-of-kin for acceptance. Adverse effects would be monitored after deprescribing.
Primary outcome was the change in the number of regular medications at 6 months. Secondary outcomes included adverse clinical outcomes (mortality, emergency hospitalizations, admissions for major cardiovascular events and gastrointestinal bleeding), changes in prescription rates of medications and acceptance of deprescribing recommendations.
Result & Outcome :
Deprescribing group (n = 90) and control group (n = 88) participants aged 90.1 ± 8.1 years were prescribed 5.8 ± 2.8 and 5.4 ± 2.7 medications at baseline (p = 0.35). At 6 months, participants of deprescribing group were taking significantly fewer medications (3.8 ± 2.3) as compared with control group (5.2 ± 2.9), p = 0.001. The mean (± SD) change in number of regular medications at 6 months was -2.0 ± 1.5 (p < 0.001) in deprescribing group and -0.2 ± 1.2 (p = 0.14) in control group. No significant differences were found between groups for mortality and other adverse clinical outcomes. The use of anti-platelets, anti-hypertensives, lipid-lowering agents, nutritional or electrolyte supplements, calcium/vitamin D, gastric acid suppressants, and appetite enhancers could be significantly reduced. Over 90% of the deprescribing recommendations were accepted.
In conclusion, our deprescribing program significantly reduced the medication burden (by a mean of 2.0 medications per person) in older RCHE residents approaching EOL, without affecting mortality and other adverse clinical outcomes. As a result, quality of life could be improved. Deprescribing should be practiced more widely in Geriatric EOL care.
