Evidence map›Paper›PMID 34707802›Full record

ReviewTherapeutic advances in drug safety2021

Impact of deprescribing dual-purpose medications on patient-related outcomes for older adults near end-of-life: a systematic review and meta-analysis.

Shakti Shrestha, Arjun Poudel, Magnolia Cardona, Kathryn J Steadman, Lisa M Nissen

Open access · goldAbstract readReview
In one paragraph

Review in Therapeutic advances in drug safety, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
11citing papers in PubMed, 1 pooled it
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

11 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. Pooled it
  2. Review
  3. Article
  4. Review
  5. The impact of palliative care consults on medicines optimisation for patients with cancer referred to hospice care at the end of life: a retrospective cohort study.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2025
    Article
  6. Article
  7. Article
  8. Article
  9. Article
  10. Article
  11. Impact of Specialized Clinics on Medications Deprescribing in Older Adults: A Pilot Study in Ambulatory Care Clinics in a Teaching Hospital.Saudi pharmaceutical journal : SPJ : the official publication of the Saudi Pharmaceutical Society · 2022
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors at 3 institutions in 1 country.

Shakti ShresthaSchool of Pharmacy, The University of Queensland, Pharmacy Australia Centre of Excellence, Level 4, 20 Cornwall Street, Woolloongabba, Brisbane, QLD 4102, Australia.ORCID https://orcid.org/0000-0003-0344-091X
Arjun PoudelSchool of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
Magnolia CardonaEBP Professorial Unit, Gold Coast University Hospital, Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia.
Kathryn J SteadmanSchool of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.
Lisa M NissenSchool of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
Queensland University of Technology · AUThe University of Queensland · AUBond University · AU

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

introductionThe decision to deprescribe medications used for both disease prevention and symptom control (dual-purpose medications or DPMs) is often challenging for clinicians. We aim to establish the impact of deprescribing DPMs on patient-related outcomes for older adults near end-of-life (EOL).

methodsThis systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline. Literature was searched on PubMed, EMBASE, CINAHL, PsycINFO and Google Scholar until December 2019 for studies on deprescribing intervention with a control group (with or without randomisation); targeting ⩾65-year olds, at EOL, with at least one life-limiting illness and at least one potentially inappropriate DPM. We were interested in any patient-related outcomes. Studies with similar outcome assessment criteria were subjected to meta-analysis and narrative synthesis otherwise. The risk of bias was assessed using Cochrane Risk of Bias and ROBINS-I tools for randomised controlled trials (RCTs) and quasi-experimental non-randomised controlled studies, respectively.

resultsFive studies covering 689 participants with mean age 81.6-85.7 years, the majority (74.6-100%) with dementia were included. The risk of bias was moderate to low. The deprescribing of DPMs lowered the risk of mortality (risk ratio (RR) = 0.59, 95% confidence interval (CI) = 0.44-0.79) and referral to acute care facilities (RR = 0.40, 95% CI = 0.22-0.73), but did not have a significant impact on the risk of falls, non-vertebral fracture, emergency presentation, unplanned hospital admission, or general practitioner visits. No significant difference was observed in the quality of life, physical and cognitive functions between the intervention and control groups.

conclusionThere is some evidence that deprescribing of DPMs for older adults near the EOL can lower the risk of mortality and referral to acute care facilities, but there are insufficient good-quality studies powered to confirm a benefit in terms of quality of life, physical or cognitive function, health service utilisation and adverse events. PLAIN LANGUAGE SUMMARY:

Indexed as

deprescribingend of lifelimited life expectancyolder adultspotentially inappropriate medication

Identifiers

PMID34707802
PMCPMC8543710
OpenAlexW3210952634

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

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.