Deprescribing preventive medications in older adults with advanced frailty, dementia, or limited life expectancy: a systematic review and meta-analysis
Abstract
OBJECTIVE: Polypharmacy and long-term preventive medication use are common in frail older adults with limited life expectancy, despite uncertain benefits and potential risks. This systematic review and meta-analysis synthesized evidence on the effect of deprescribing preventive medications (antihypertensives, statins, anticoagulants, and antidiabetic agents) compared to continuation on clinical, physiological, safety, and patient-centered outcomes among older adults with advanced frailty, dementia, or limited life expectancy. METHODS: PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and ProQuest Dissertations & Theses Global were searched for eligible randomized controlled trials and observational studies. The primary outcome was all-cause mortality. Secondary outcomes were hospitalization, major adverse cardiovascular events (MACE), changes in blood pressure, risks of fractures and falls, and quality of life. Data were pooled (relative risk [RR] or mean difference or standardized mean difference) using random-effects models (RevMan version 5.4). The evidence certainty was evaluated by the GRADE framework (PROSPERO ID: CRD420251147086). RESULTS: From 10,397 records, 15 studies (> 33,000 participants) were included. Overall, deprescribing was not associated with increased risk of all-cause mortality (RR: 1.15, 95% CI: 0.98–1.35, I2: 93%), hospitalization (RR: 0.93, 95% CI: 0.82–1.07, I2: 68%), or MACE (RR: 1.37, 95% CI: 0.70–2.70, I2: 95%) (certainty: very low…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 33,000 participants or records.
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