Conclusions
Decisions on the target and scope of deprescribing interventions have
many implications. Some scenarios may add further complexity, such as
interventions targeting fall-risk increasing drugs. Although these
medications share a common adverse event, they are likely to represent a
diverse group of medication classes, including benzodiazepines,
antihypertensives, and antimuscarinics, which may each require a
different, tailored approach to deprescribe. However, this does also
differ from studies which aim to optimise all medications a person may
be taking, in that sub-optimal prescribing of medications unrelated to
falls may not be addressed, if considered out of the scope of the
intervention. Similarly there may be grey areas with regard to
intervention scope (particularly if not clearly described in the study
report), and even when broader medicines optimisation is explicitly
specified as the scope, deprescribing actions may predominate.
For studies evaluating interventions that aim to promote deprescribing,
decisions on targeting one medicine or many, and extending the scope
from deprescribing to medicines optimisation are critical. Focusing on
these choices will clarify approaches to study design, and help to
advance the field of deprescribing.
Acknowledgements: FM was a member of the Junior Investigator
Intensive Program of the US Deprescribing Research Network, which is
funded by the National Institute on Aging (R24AG064025).
Conflict of Interest Statement: None.