Deprescribing

Multimorbidity and polypharmacy are major challenges for the ageing population. Deprescribing, which is the clinically supervised withdrawal of medications when the harms outweigh the benefits for an individual, is a strategy to reduce inappropriate polypharmacy. Deprescribing is particularly relevant for frail older adults. Frail older adults may have altered physiology, resulting in pharmacokinetic and pharmacodynamic changes, predisposing them to higher risk of harm from inappropriate medications. Polypharmacy may also contribute to frailty. Studies have explored the impact of deprescribing in frailty on prescribing, safety, and clinical outcomes but more experimental interventional research is needed. Deprescribing complements other geriatric management strategies and is best implemented by a multidisciplinary team. This chapter discusses the concept of deprescribing, why it is relevant in frailty, the direct evidence of deprescribing in frailty, how it relates to other frailty interventions and a framework for medication review including deprescribing for frail older adults.