New Delhi: Older adults with advanced frailty often take multiple long-term preventive medicines, despite uncertain benefits and potential risks. An analysis of 15 published studies, covering more than 33,000 participants and databases including the ‘PubMed’ and ‘Web of Science’, found that de-prescribing such medicines was not associated with a higher risk of death, hospitalisation, or major adverse cardiovascular events (MACE). Findings published in BMC Geriatrics also showed no increase in falls, fractures, or deterioration of quality of life, outcomes often linked to disability among older adults.
Researchers, including those from the Indian Council of Medical Research-National Institute for Research in Bacterial Infections, Kolkata, and Sweden’s Karolinska Institutet, noted that overall certainty of evidence was low. The review focused on frail older adults, including those living with dementia or limited life expectancy, and highlighted that further high-quality studies are needed to strengthen guidance on safe de-prescribing practices.
De-prescribing preventive medicines in frail adults
Analysis and methodology
Researchers reviewed 10,397 records and included 15 studies for final analysis. The studies examined the effects of stopping preventive medicines such as antihypertensives, statins, and antidiabetics, compared to continuing them, on clinical, physiological, safety, and patient-centred outcomes in older adults with advanced frailty or limited life expectancy.
Mortality, hospitalisation and major heart events
The analysis found that de-prescribing preventive medications in frail or palliative older adults was not associated with increased risk of all-cause mortality, hospital admission, or MACE. “From 10,397 records, 15 studies were included. Overall, de-prescribing was not associated with increased risk of all-cause mortality, hospitalisation, or MACE (certainty: very low GRADE),” the authors wrote.
Falls, fractures and quality of life
Falls are a leading cause of disability among older adults. The study found that stopping preventive medications did not increase the risk of falls or fractures, nor did it reduce quality of life.
Blood pressure changes after de-prescribing
The analysis noted a slight increase in systolic blood pressure when antihypertensives were deprescribed. Researchers emphasised that monitoring remains essential to ensure patient safety.
Polypharmacy and limited life expectancy
Frail older adults with limited life expectancy are often prescribed multiple long-term preventive medications, a practice known as “polypharmacy,” despite unclear benefits. The authors concluded: “De-prescribing preventive medications in frail or palliative older adults was not associated with worse outcomes. However, evidence certainty was very low, and further studies are needed.”
The study provides important evidence that cautious, individualised review of preventive medicines can be undertaken safely in older adults, while underscoring the need for stronger research to inform routine clinical practice.
(With inputs from agencies)