How does deprescribing (not) reduce mortality? A review of a meta-analysis in community-dwelling older adults casts uncertainty over claimed benefits

Abstract

Some meta-analyses suggest that deprescribing may reduce mortality. Our aim was to determine the underlying factors contributing to this observed reduction. We analysed data from 12 randomized controlled trials included in the latest meta-analysis on deprescribing in community-dwelling older adults. Our analysis focused on deprescribed medications and potential methodological concerns. Only a third (4/12) of the trials aimed to study mortality, and that too as a secondary outcome. Five trials reported a reduction in total medications, potentially inappropriate medications or drug-related problems. Information on specific classes of deprescribed medications was limited, although a wide array was concerned (e.g., antihypertensive, sedative, gastro-intestinal medications and vitamins). Follow-up periods were ≤1 year in 11 trials, and five trials included ≤150 participants. Small sample sizes often resulted in imbalanced groups (e.g., comorbidities, number of potentially inappropriate medications), yet no trials presented multivariable analyses. In the two trials with the most weight in the meta-analysis, several deaths occurred before the intervention, making it difficult to draw conclusions about the impact of the deprescribing intervention on mortality. These methodological issues cast significant uncertainty on the benefits of deprescribing on mortality outcomes. Large-scale, well-designed trials are needed to address this issue effectively.