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How “age-friendly” are deprescribing interventions?

Wang J, Shen JY, Conwell Y, et al. How “age-friendly” are deprescribing interventions? A scoping review of deprescribing trials [published online ahead of print, 2022 Oct 11]. Health Serv Res. 2022;10.1111/1475-6773.14083. doi:10.1111/1475-6773.14083

The 4Ms (“Medication,” “Mentation,” “Mobility,” and “What Matters Most”) are considered essential components of age-friendly health systems. Age-friendly health systems are better equipped to handle the most pressing health concerns facing older adults. Given that over a third of older adults use potentially inappropriate or unnecessary medications (PIMs), effective, patient-centered deprescribing interventions are expected to incorporate the 4Ms of age-friendly care.

After conducting a scoping review of deprescribing trials, a team mentored by USDeN pilot core leaders Amanda Mixon and Sandra Simmons found that “Mentation,” “Mobility,” and “What Matters Most,” are considered to varying degrees in the intervention design and outcome assessment. In this review, 37 studies were selected for their focus on specific deprescribing interventions and inclusion of older adults. Regarding intervention design, all studies considered “Medication,” eight considered “Mentation,” two considered “Mobility,” and six considered “What Matters Most.” Regarding outcome assessment, 33 studies included “Medication” outcomes, 13 considered “Mobility” outcomes, 10 considered “Mentation” outcomes, and no study explicitly considered “What Matters Most” outcomes. Variation in the consideration of the 4Ms, particularly in terms of outcomes relevant to “What Matters Most,” reveals a gap in the literature on deprescribing. Measures of “What Matters Most” can include quality of life, well-being, sleep, patient attitudes and beliefs, and social engagement. Deprescribing is likely more effective when health care providers account for these age-friendly concepts and related outcome measures. Researchers conclude that future deprescribing interventions should prioritize patients’ priorities in both intervention design and outcome assessment.

Primary author and USDeN pilot awardee Dr. Jinjiao Wang discusses the existing barriers to inclusion of the 4Ms in deprescribing trials, as well as the steps researchers can take to address them:

“Considering all 4Ms in intervention design, sample selection, and outcome assessment may be difficult or unrealistic in traditional trial designs. To address this, pragmatic designs and approaches should be adopted in deprescribing research. For example, researchers can try utilizing the measures already collected in routine practice to see if changes in Mentation, Mobility and What Matters occur. Some of the administrative assessment tools, such as the Outcome and Assessment Information Set (OASIS) in home healthcare and the Minimum Data Set (MDS) in skilled nursing facilities, may be useful. As a larger number of healthcare institutions collect patient-reported outcomes (PROs) regularly, these PROs may be another resource to tap into for outcome measurement of the 4Ms.”

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