Subtopic Deep Dive
Deprescribing Older Adults
Research Guide
What is Deprescribing Older Adults?
Deprescribing in older adults involves systematically discontinuing unnecessary medications to reduce polypharmacy risks while maintaining health outcomes.
This subtopic focuses on protocols, tools, and trials for safe medication cessation in geriatric populations. Key works include Scott et al. (2015) with 1421 citations on reducing inappropriate polypharmacy and Rankin et al. (2018) Cochrane review (488 citations) evaluating interventions. Over 10 listed papers since 2014 provide evidence on feasibility, mortality effects, and frailty-specific criteria.
Why It Matters
Deprescribing protocols like STOPPFrail (Lavan et al., 2017) reduce adverse events, hospitalizations, and mortality in frail older adults with limited life expectancy. Scott et al. (2015) highlight polypharmacy's burden of disability and death, while Page et al. (2016) meta-analysis (460 citations) confirms deprescribing's safety and health benefits. Reeve et al. (2014) evidence-based process supports patient-centered decisions, alleviating polypharmacy prevalence noted in Delara et al. (2022) meta-analysis (297 citations).
Key Research Challenges
Sustaining deprescribing post-trial
Long-term adherence to deprescribed regimens remains low despite initial success. Bloomfield et al. (2020) meta-analysis shows community-dwelling adults revert to polypharmacy without ongoing support. Ibrahim et al. (2021) review identifies frailty complicating sustained reductions.
Balancing risks in frailty
Deprescribing frail patients risks withdrawal effects versus ongoing harms. Potter et al. (2016) RCT demonstrates feasibility but notes mortality variability. Lavan et al. (2017) STOPPFrail criteria address limited life expectancy yet require validation.
Implementing shared decisions
Patient-provider alignment on goals hinders uptake. Reeve et al. (2014) patient-centered process lacks widespread adoption tools. Rankin et al. (2018) interventions show mixed professional implementation results.
Essential Papers
Reducing Inappropriate Polypharmacy
Ian Scott, Sarah N. Hilmer, Emily Reeve et al. · 2015 · JAMA Internal Medicine · 1.4K citations
Inappropriate polypharmacy, especially in older people, imposes a substantial burden of adverse drug events, ill health, disability, hospitalization, and even death. The single most important predi...
Interventions to improve the appropriate use of polypharmacy for older people
Audrey Rankin, Cathal Cadogan, Susan Patterson et al. · 2018 · Cochrane Database of Systematic Reviews · 488 citations
BACKGROUND: Inappropriate polypharmacy is a particular concern in older people and is associated with negative health outcomes. Choosing the best interventions to improve appropriate polypharmacy i...
The feasibility and effect of deprescribing in older adults on mortality and health: a systematic review and meta‐analysis
Amy Page, Rhonda Clifford, Kathleen N. Potter et al. · 2016 · British Journal of Clinical Pharmacology · 460 citations
Aims Deprescribing is a suggested intervention to reverse the potential iatrogenic harms of inappropriate polypharmacy. The review aimed to determine whether or not deprescribing is a safe, effecti...
Review of deprescribing processes and development of an evidence‐based, patient‐centred deprescribing process
Emily Reeve, Sepehr Shakib, Ivanka Hendrix et al. · 2014 · British Journal of Clinical Pharmacology · 375 citations
Inappropriate use of medication is widespread, especially in older people, and is associated with risks, including adverse drug reactions, hospitalization and increased mortality. Optimization of a...
Prevalence and factors associated with polypharmacy: a systematic review and meta-analysis
Mahin Delara, Lauren Murray, Behnaz Jafari et al. · 2022 · BMC Geriatrics · 297 citations
STOPPFrail (Screening Tool of Older Persons Prescriptions in Frail adults with limited life expectancy): consensus validation
Amanda Lavan, Paul Gallagher, Carole Parsons et al. · 2017 · Age and Ageing · 280 citations
STOPPFrail comprises 27 criteria relating to medications that are potentially inappropriate in frail older patients with limited life expectancy. STOPPFrail may assist physicians in deprescribing m...
A systematic review of the evidence for deprescribing interventions among older people living with frailty
Kinda Ibrahim, Natalie Cox, Jennifer M Stevenson et al. · 2021 · BMC Geriatrics · 237 citations
Abstract Background Older people living with frailty are often exposed to polypharmacy and potential harm from medications. Targeted deprescribing in this population represents an important compone...
Reading Guide
Foundational Papers
Start with Reeve et al. (2014) for evidence-based patient-centered process (375 citations), then Scott et al. (2015) for polypharmacy burden rationale, as they establish core deprescribing frameworks.
Recent Advances
Study Page et al. (2016) meta-analysis for mortality evidence, Lavan et al. (2017) STOPPFrail for frailty tools, and Ibrahim et al. (2021) review for targeted interventions in frail populations.
Core Methods
Core techniques include screening criteria (STOPPFrail), systematic reviews/meta-analyses (Cochrane GRADE), RCTs for feasibility (Potter et al., 2016), and shared decision protocols (Reeve et al., 2014).
How PapersFlow Helps You Research Deprescribing Older Adults
Discover & Search
Research Agent uses searchPapers on 'deprescribing frail older adults' to retrieve Scott et al. (2015, 1421 citations), then citationGraph maps forward citations to Lavan et al. (2017) STOPPFrail, and findSimilarPapers links to Ibrahim et al. (2021) frailty review; exaSearch drills into polypharmacy meta-analyses like Delara et al. (2022).
Analyze & Verify
Analysis Agent applies readPaperContent to extract protocols from Reeve et al. (2014), verifies meta-analysis effects via verifyResponse (CoVe) on Page et al. (2016), and uses runPythonAnalysis for GRADE grading of Rankin et al. (2018) Cochrane evidence, confirming low heterogeneity in deprescribing outcomes with statistical tests.
Synthesize & Write
Synthesis Agent detects gaps in long-term sustainability from Bloomfield et al. (2020) via gap detection, flags contradictions between RCTs like Potter et al. (2016) and reviews; Writing Agent employs latexEditText for protocol drafts, latexSyncCitations integrates Scott et al. (2015), and latexCompile generates frailty deprescribing guidelines with exportMermaid for decision flowcharts.
Use Cases
"Meta-analyze mortality effects of deprescribing in frail elderly from recent RCTs."
Research Agent → searchPapers + citationGraph (Page 2016, Potter 2016) → Analysis Agent → runPythonAnalysis (pandas meta-regression on effect sizes) → GRADE-assessed summary table output.
"Draft LaTeX guideline for STOPPFrail implementation in geriatrics clinics."
Synthesis Agent → gap detection (Lavan 2017 vs. Ibrahim 2021) → Writing Agent → latexEditText + latexSyncCitations (Reeve 2014) + latexCompile → formatted PDF guideline with citations.
"Find open-source tools for polypharmacy screening in deprescribing."
Research Agent → searchPapers 'deprescribing tools' → Code Discovery (paperExtractUrls → paperFindGithubRepo → githubRepoInspect) → validated STOPPFrail calculator repo linked to Scott et al. (2015).
Automated Workflows
Deep Research workflow conducts systematic review of 50+ deprescribing papers starting with searchPapers on Scott et al. (2015), yielding structured report with GRADE tables. DeepScan applies 7-step analysis to Reeve et al. (2014) process, checkpoint-verifying feasibility via CoVe. Theorizer generates hypotheses on frailty-specific protocols from Lavan et al. (2017) and Potter et al. (2016) RCT data.
Frequently Asked Questions
What is deprescribing in older adults?
Deprescribing systematically stops unnecessary medications to minimize polypharmacy harms like adverse events and hospitalization (Scott et al., 2015; Reeve et al., 2014).
What methods improve polypharmacy in elderly?
Interventions include pharmacist-led reviews and tools like STOPPFrail; Rankin et al. (2018) Cochrane review assesses multifaceted strategies for appropriate use.
What are key papers on deprescribing?
Scott et al. (2015, 1421 citations) on reducing polypharmacy; Page et al. (2016, 460 citations) meta-analysis on mortality; Lavan et al. (2017) STOPPFrail validation.
What open problems exist?
Sustaining deprescribing long-term, implementing in frailty without withdrawal risks, and scaling shared decision tools (Bloomfield et al., 2020; Ibrahim et al., 2021).
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