Outcomes of deprescribing for people with life-limiting conditions: A systematic review

Abstract

Background: Polypharmacy and inappropriate medication are common amongst people with life-limiting conditions. Whilst deprescribing may help reduce these medication-related issues, supporting evidence in this population group is limited. Aim: To synthesise evidence on the outcomes of deprescribing in people with life-limiting conditions. Design: Systematic review. Data source: MEDLINE, Embase, Scopus, PsycINFO and CINAHL were searched. Original studies published between Jan 2000 and Dec 2024 in English were included. Result: A total of 17,457 hits were screened, of which 46 original studies met the inclusion criteria. Most eligible studies were pre-post interventional (n = 14) or cohort studies (n = 14), conducted primarily in nursing homes or long-term care facilities (n = 20) and hospitals (n = 16). The majority originated from North America (n = 20) and Australia (n = 7). A wide range of outcome variables were examined, with a primary focus on clinical outcomes. All studies assessing the impact on the number of medications used reported either a reduction in overall medication burden or inappropriate medications (n = 15), or no significant change (n = 3). Regarding mortality, most studies (10 studies) reported no impact, while 3 studies each reported increased and decreased mortality. For other outcomes, the majority of studies reported that deprescribing had no effect. Conclusion: This systematic review suggests that deprescribing offers some benefits, including reduced medication burden and costs in people with life-limiting conditions. While there is no strong evidence for harm, a small proportion of patients reported increased risks, so careful monitoring is essential. Further research should explore how deprescribing outcomes vary by disease condition and medication type.