What is deprescribing and why does it matter?
Medicines play an important role in preventing and managing symptoms towards the end of life. However, polypharmacy, which usually refers to the regular use of five or more medicines by a person, may need to be reviewed. As quality of life is prioritised as part of palliative care, medication reviews can help to identify inappropriate polypharmacy and ensure medications align with a person-centred care plan. [1] When the risks outweigh the benefits, a decision is made by health professionals to taper and/or discontinue medications – this is known as 'deprescribing'. [1, 2]
Deprescribing should be considered for older people at the end of life. [2] It can help reduce medication side effects, pill burden, and the risk of drug interactions. [3] In a palliative care context, it is also important that deprescribing supports prioritising medications that are essential for managing symptoms such as pain. [4]
Want to learn more?
Visit the Reducing Care Burden page on the palliAGED website for more information on deprescribing.
The RACGP aged care clinical guide (Silver Book) has a section dedicated for GPs on deprescribing.
What can we do?
Medication review and deprescribing plan
Care teams:
- Review medications regularly in a timely manner to see whether they continue to provide benefits while minimising any potential burdens or harms to the older person at the end of life.
Organisations:
- Establish deprescribing policies tailored for care at the end of life to assist GPs, specialists, and health professionals who can deprescribe.
- Ensure an appropriate person-centred deprescribing plan is developed and implemented to facilitate safe discontinuation of medication(s), working with the wider care team and the person’s GP.
The evidence:
- The proportion of Veteran residents who were deprescribed statins was higher for those who were end-of-life recognised compared to those who were not. [5]
- Use of a deprescribing tool can help pharmacists and doctors flag particular medicines for deprescribing. [6]
- Medication management protocols are seen by GPs as a means to facilitate deprescribing efforts by health professionals within residential aged care facilities. [6]
Communication and shared decision making
Aged care workers:
- Discuss the deprescribing process, the rationale for it, and any potential concerns with the older person and their family members/carers. Have these conversations empathetically.
- Emphasise that discontinuing medications (i.e., deprescribing) is not the same as withdrawing care.
- Assure them that all efforts to provide appropriate comfort and support will continue.
The evidence:
- Doctors want to involve older people and their families in treatment decision making. [6]
- People’s views on medications and their use can affect their receptivity to changes in their treatment regimen. [6]
- Doctors are also concerned about how deprescribing will be seen by older people e.g., that others are giving up on them or disregarding their medical condition(s). [6]
Education and training
Health professionals:
- Identify gaps in knowledge and understanding, relevant to your role, related to deprescribing practices and seek opportunities to upskill.
Organisations:
- Enable care staff working in palliative care settings with the capacity to understand deprescribing processes and its role in care.
- Put into place opportunities for role-relevant education and training.
The evidence:
- Health professionals may perceive that they do not have the right skills for deprescribing. [6]
- Effective interprofessional collaboration can be challenging to navigate in light of views on the professional input provided by care team members. [6]
- Doctors face pressure from nursing staff as well as families and older people to prescribe particular medicines. [6]
- Limited education and information given to support evidence-based deprescribing practices has been reported among GPs. [6] In particular, health professionals have called for further education of nursing staff to support deprescribing processes. [6]