Deprescribing in older people: development and evaluation of complex healthcare interventions

Inappropriate prescribing in older people is common and has been associated with increased adverse drug reactions, morbidity, hospitalisations and decreased quality of life. Deprescribing is the process of withdrawing inappropriate medications. It is a complex healthcare intervention as it involves various stakeholders, such as doctors, pharmacists, patients and patients’ caregivers. Complex healthcare interventions need to be properly developed and evaluated implemented in practice. The aim of this thesis was to develop and evaluate pharmacist-led interventions for deprescribing in older people, by identifying opportunities for deprescribing, evaluating a current deprescribing intervention and developing and evaluating a new deprescribing intervention. All studies in this thesis focused on specific subpopulations of older people at high risk for medication related harm, investigated different potentially inappropriate medications and used different study designs. We found that opportunities for deprescribing exist in older populations, such as high prescribing of preventive medications at the end of life in older nursing home residents (retrospective cohort study) and anticholinergic/sedative medications in older community-dwelling adults (cross sectional study). To reduce a high anticholinergic/sedative load in community-dwelling older adults, medication reviews, as currently performed in the Netherlands, are not effective (randomized controlled trial). An innovative deprescribing intervention using information technology to target newly prescribed anticholinergic/sedative medication in this population seems more successful (prospective intervention study). Future deprescribing strategies should be patient-centred, targeted to the right population and medication, tailored to patient’s needs and have a high degree of interprofessional collaboration