Deprescribing: Evidence Base and Implementation

The link between polypharmacy and medication adversity in multimorbid older people has been well established for several decades. The impetus for evidence-based prescribing is one of the main reasons for problematic polypharmacy in multimorbid older people, as prescribers try to offer these patients the full list of evidence-based pharmacotherapeutic agents for each individual chronic condition. In addition, many older people attend several physicians who prescribe only for the specific condition they are treating and not always with due regard for the various other medications prescribed for concurrent medical conditions in the same patient. Once polypharmacy is established and particularly if it is technically evidence-based, it can be challenging for the patient’s primary care physician or geriatrician to institute deprescribing, that is, considered removal of one or more medications from the list of drugs that the patient consumes each day. In this chapter, we examine various approaches to deprescribing in multimorbid older people, with particular emphasis on the guiding principle of ‘what matters most to the patient?’, patient quality of life and minimizing iatrogenic harm.