Overviews of polypharmacy and deprescribing:
Todd, Adam, et al. The deprescribing rainbow: a conceptual framework highlighting the importance of patient context when stopping medication in older people. BMC geriatrics 18.1 (2018): 295.
Hilmer, Sarah N., and Danijela Gnjidic. Deprescribing: the emerging evidence for and the practice of the ‘geriatrician’s salute’. Age and Ageing 2018;47(5):638-640
NHMRC Cognitive Decline Partnership Centre, University of Sydney, in Collaboration with the Australian Deprescribing Network and NPS MedicineWise. Quality Use of Medicines to Optimise Ageing in Older Australians: Recommendations for a National Strategic Action Plan to Reduce Inappropriate Polypharmacy (2018). Sydney, NSW, Australia. ISBN: 978-0-6482658-6-3
Reeve E, Thompson W, Farrell B. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European Journal of Internal Medicine 2017;38:3-11. doi: 10.1016/j.ejim.2016.12.021. Epub 2017 Jan 5.
Zelmer J. De-prescribing: When less is more in healthcare. Healthcare Policy 2016;11(3):6-9.
Reeve E, Denig P, Hilmer SN, Ter Meulen R. The Ethics of Deprescribing in Older Adults. J Bioeth Inq. 2016 Dec;13(4):581-590. doi: 10.1007/s11673-016-9736-y
Scott, Ian A., et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA internal medicine 2015; 175.5;827-834.
Scott IA, Anderson K, Freeman CR, et al. First do no harm: a real need to deprescribe in older patients. Med J Aust 2014;201(7):390-2.
Kwan D, Farrell B. Polypharmacy: Optimizing medication use in elderly patients. Pharmacy Practice 2013;Apr/May:20-25.
Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009;85(1):86-8 doi: 10.1038/clpt.2008.224.
General approaches and algorithms to help with deprescribing decisions:
Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, Bonner C, Doust J, Colvin J, Heaney A, Turner R, McCaffery K. Too much medicine in older people? Deprescribing through shared decision making. BMJ 2016;353:i2893
Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014 Oct; 78(4): 738–747. doi: 10.1111/bcp.12386
Lemay G, Daziel B. Better prescribing in the elderly. Can Geriatrics Society Journal of CME 2012; 2(3);20-26.
Hardy JE, Hilmer SN. Deprescribing in the last year of life. J Pharm Pract Res 2011;41:146-151.
Bain KT, Holmes HM, Beers MH, Maio V, Handler SM, Pauker SG. Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process. J Am Geriatr Soc. 2008;56(10):1946-52.
Graves T, Hanlon JT, Schmader KE et al. Adverse events after discontinuing medications in elderly outpatients. Arch Intern Med 1997;157:2205-10.
Summaries of patient and physician attitudes, challenges, and enablers to deprescribing:
Reeve E, Anthony AC, Kouladjian O’Donnell L, Low L-F, Ogle, SJ, Glendenning JE, Lorang CEB, Hilmer SN. Development and pilot testing of the revised Patients’ Attitudes Towards Deprescribing questionnaire for people with cognitive impairment. Australasian Journal on Ageing. Aug 2018 https://onlinelibrary.wiley.com/doi/abs/10.1111/ajag.12576
Conklin J, Farrell B, Suleman S. Implementing deprescribing guidelines into frontline practice: Barriers and facilitators. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2018.08.012 (Free access until August 2019)
Paque, Kristel, et al. Barriers and enablers to deprescribing in people with a life-limiting disease: A systematic review. Palliative medicine (2018): 0269216318801124.
Turner J, Edwards S, Stanners M, Shakib S, Bell JS. What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open 2016;6:e009781 doi:10.1136.
Reeve E, Low L-F, Shakib S, Hilmer S. Development and validation of the revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire: Versions for older adults and caregivers. Drugs and Aging. 2016;33(12): 913-928 https://link.springer.com/article/10.1007/s40266-016-0410-1
Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimizing potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open 2014;4:e006544 doi: 10.1136/bmjopen-2014-006544
Reeve E, Shakib S, Hendrix I, et al. The benefits and harms of deprescribing. Med J Aust 2014;201(7):386-9
Reeve E, To E, Hendrix I, Shakib S, Roberts MS, Wiese MD. Patient barriers to and enablers of deprescribing: a systematic review. Drugs Aging 2013;30(10):793-807.
Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012;13:56.
Polypharmacy and deprescribing research:
Beuscart JB, Knol W, Cullinan S, Schneider C, Dalleur O, Boland B, Thevelin S, A.F. Jansen P, O’Mahony D, Rodondi N, Spinewine A. International core outcome set for clinical trials of medication review in multi-morbid older patients with polypharmacy. BMC Medicine201816:21. https://doi.org/10.1186/s12916-018-1007-9
Thompson W, Reeve E, Moriarty F, Maclure M, Turner JP, A. Steinman M, Conklin J, Dolovich L, McCarthy L, Farrell B. Deprescribing: Future directions for research. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2018.08.013 (Free access until August 2019)
Rankin A, Cadogan CA, In Ryan C, Clyne B, Smith SM, Hughes CM. Core Outcome Set for Trials Aimed at Improving the Appropriateness of Polypharmacy in Older People in Primary Care. J Am Geriatr Soc. 2018 Jul;66(6):1206-1212. doi: 10.1111/jgs.15245.
Raman-Wilms L, Farrell B, Sadowski C, Austin Z. Deprescribing: An educational imperative. Research in Social and Administrative Pharmacy. https://doi.org/10.1016/j.sapharm.2018.08.011 (Free access until August 2019)
Case reports on polypharmacy management that give examples of deprescribing (from the Bruyère Continuing Care Geriatric Day Hospital in Ottawa, Canada):
Commentaries about the case reports (intro to the series)
Farrell B, Shamji S, Monahan A, French Merkley V. Clinical vignettes to help you deprescribe medications in elderly patients: introduction to the polypharmacy case series. Canadian Family Physician 2013;59:1257-1258.
Farrell B, Shamji S, Monahan A, French Merkley V. Reducing polypharmacy in the elderly: Cases to help you rock the boat. Canadian Pharmacists Journal 2013;146(5):243-244.
Farrell B, Eisener-Parsche P, Dalton D. Turning over the rocks – the role of anticholinergics and benzodiazepines in cognitive decline and falls. Canadian Family Physician 2014;60:345-350.
Farrell B, Monahan A, Thompson W. Revisiting ongoing medication use in a frail 93 year old experiencing possible adverse effects. Canadian Medical Association Journal 2014;186:445-449. doi:10.1503/cmaj.130523.
Farrell B, Shamji S, Dalton D. Managing chronic disease in the frail elderly – more than just adhering to clinical guidelines. Canadian Pharmacists Journal 2014;147(2):89-96.
Farrell B, Monahan A, Ingar N. Identifying and managing drug-related causes of common geriatric symptoms. Canadian Family Physician 2014;60:147-153.
Farrell B, French Merkley V, Ingar N. Reducing pill burden and helping with medication awareness to improve adherence. Canadian Pharmacists Journal 2013;146(5):262-269.
Farrell B, French Merkley, Thompson W. Managing polypharmacy in a 77-year-old woman with multiple prescribers. CMAJ 2013;185:1240-1245.
Farrell B, Shamji S, Ingar N. Reducing fall risk while managing hypotension, pain and poor sleep in an 83 year old woman. Canadian Family Physician 2013;59:1300-1305.
Farrell B, Shamji S, Ingar N. Reducing fall risk while managing pain and insomnia: addressing polypharmacy in an 81 year old woman. Canadian Pharmacists Journal 2013;146(6):335-341.
In this section
- “Talking About Your Medications” Workshop Series
- Case Reports and Testimonials
- Deprescribing Guideline Symposium Resources
- Deprescribing Guidelines and Algorithms
- Deprescribing in Ontario Long-Term Care
- Deprescribing Information Pamphlets
- Deprescribing Webinars
- Frequently Asked Questions
- Helpful Links
- PPI Deprescribing Patient Decision Aid