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New clinical practice guidelines represent a major step in supporting safe and appropriate use of medicines in older people
Guidelines for deprescribing medications in older people encourages prescribers to consider the need for a medicine each time a prescription is re-issued, potentially reducing the risk of medicine-related harm as well as improving individual health outcomes. A summary of the guidelines has been published in the Medical Journal of Australia.
The purpose of the guideline
Older people face higher risks of medicine-related harm due to polypharmacy and the use of potentially inappropriate medicines. Current treatment guidelines rarely specify when to stop medicines, leading to medicines often being continued indefinitely without a clear deprescribing plan. While deprescribing guidelines exist for some medicine classes, limited guidance is a major barrier to deprescribing. These new guidelines address this gap by providing structured recommendations that complement more detailed drug-specific deprescribing guidance, disease-specific therapeutic guidelines and non-pharmacological management resources. These guidelines were developed by a team of 72 experts, including consumer representatives, and were further shaped by feedback from public consultation and independent reviewers.
Main Recommendations
The guidelines are intended for all healthcare professionals involved in prescribing, dispensing or administering medicines to older people. The guidelines specifically address polypharmacy and medicines commonly dispensed for regular use in people aged ≥ 65 years, as well as other medicines where there is evidence to consider deprescribing in this cohort. The guidelines provide 185 consensus-based recommendations and 70 good practice statements, covering both specific medicine categories and general deprescribing principles. The guidelines are structured into four areas:
- when to deprescribe;
- ongoing treatment needs;
- how to deprescribe; and
- monitoring requirements.
Changes in Care as a Result of the Guideline
This guideline emphasises deprescribing as an integral part of the prescribing continuum. Applying a deprescribing approach encourages prescribers to consider the ongoing need for a medicine each time a prescription is re-issued, to balance benefits and harms as they evolve over time, and to ensure treatment decisions reflect an individual’s goals through shared decision-making. The guideline was developed based on currently available evidence for deprescribing and expert multidisciplinary and consumer input. It supports health professionals in reviewing regular medicines, minimising harm and planning ongoing treatment or monitoring.
The detailed guideline is available at https://deprescribing.com.
Read the guideline summary in the Medical Journal of Australia.
Annika Howells is the sub-editor of the MJA’s InSight+.
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