ReviewTherapeutic advances in drug safety2018
Principle of rational prescribing and deprescribing in older adults with multiple chronic conditions.
Review in Therapeutic advances in drug safety, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Patient Preferences for Discussing Life Expectancy: a Systematic Review.Journal of general internal medicine · 2021Pooled it
- DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities.International journal of clinical pharmacy · 2019Trial
- Communication as Mediator: Interprofessional Deprescribing and the RCC (Roles-Collaboration-Communication) Framework.Healthcare (Basel, Switzerland) · 2026Article
- Real-world treatment courses after anti-TNF de-escalation in older adults with rheumatoid arthritis: a medicare cohort study.BMC rheumatology · 2026Article
- Prevalence and Factors Associated with De-escalation of Anti-TNFs in Older Adults with Rheumatoid Arthritis: A Medicare Claims-Based Observational Study.Drugs & aging · 2024Observational
- Effect modification of polypharmacy on incident frailty by chronic kidney disease in older adults.BMC geriatrics · 2024Article
- "I think deprescribing is very needed in our society:" Healthcare Professional Students Perceptions of Deprescribing Education.Innovations in pharmacy · 2024Article
- Central Nervous System-Active Prescriptions in Older Veterans: Trends in Prevalence, Prescribers, and High-risk Populations.Journal of general internal medicine · 2023Article
- Automated Detection of Patients at High Risk of Polypharmacy including Anticholinergic and Sedative Medications.International journal of environmental research and public health · 2023Article
- Healthcare for Older Adults with Multimorbidity: A Scoping Review of Reviews.Clinical interventions in aging · 2023Article
- Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis.Health technology assessment (Winchester, England) · 2022Review
- Improving individualized prescription in patients with multimorbidity through medication review.BMC geriatrics · 2022Article
- Health informatics interventions to minimize out-of-pocket medication costs for patients: what providers want.JAMIA open · 2022Article
- The Smart Aging Platform for Assessing Early Phases of Cognitive Impairment in Patients With Neurodegenerative Diseases.Frontiers in psychology · 2021Article
- Multi-Morbidity and Polypharmacy in Older People: Challenges and Opportunities for Clinical Practice.Geriatrics (Basel, Switzerland) · 2020Review
- Patient-Reported Barriers and Facilitators to Deprescribing Cardiovascular Medications.Drugs & aging · 2020Article
- Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework.Journal of the American Geriatrics Society · 2019Article
- How many older adults receive drugs of questionable clinical benefit near the end of life? A cohort study.Palliative medicine · 2019Article
- Foreword to the first special collection: Addressing the invisible iatrogenic epidemic: the role of deprescribing in polypharmacy and inappropriate medication use.Therapeutic advances in drug safety · 2019Article
- "At 80 I Know Myself": Embodied Learning and Older Adults' Experiences of Polypharmacy and Perceptions of Deprescribing.Gerontology & geriatric medicineArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors.
Funding
Abstract
Although the majority of older adults in the developed world live with multiple chronic conditions (MCCs), the task of selecting optimal treatment regimens is still fraught with difficulty. Older adults with MCCs may derive less benefit from prescribed medications than healthier patients as a result of the competing risk of several possible outcomes including, but not limited to, death before a benefit can be accrued. In addition, these patients may be at increased risk of medication-related harms in the form of adverse effects and significant burdens of treatment. At present, the balance of these benefits and harms is often uncertain, given that older adults with MCCs are often excluded from clinical trials. In this review, we propose a framework to consider patients' own priorities to achieve optimal treatment regimens. To begin, the practicing clinician needs information on the patient's goals, what the patient is willing and able to do to achieve these goals, an estimate of the patient's clinical trajectory, and what the patient is actually taking. We then describe how to integrate this information to understand what matters most to the patient in the context of an array of potential tradeoffs. Finally, we propose conducting serial therapeutic trials of prescribing and deprescribing, with success measured as progress towards the patient's own health outcome goals. The process described in this manuscript is truly an iterative process, which should be repeated regularly to account for changes in the patient's priorities and clinical status. With this process, we aim to achieve optimal prescribing, that is, treatment regimens that maximize benefits that matter to the patient and minimize burdens and potential harms.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.