Draft deprescribing guideline for older people issued

Newly drafted clinical practice guidelines aim to help GPs deprescribe medications for older people – a patient cohort particularly prone to harmful polypharmacy.
 
The document, developed by the University of Western Australia, sets out recommendations to be used as part of a shared decision-making framework for patients aged over 65 and is currently out for feedback.
 
Dr Anthony Marinucci, the Chair of RACGP Specific Interests Aged Care, is one of several authors.
 
He said he became involved as he believes deprescribing practices can ‘meaningfully improve health outcomes for older Australians’.
 
‘Older adults are especially vulnerable to adverse drug events, medication interactions, and hospitalisations resulting from unnecessary or inappropriate medications,’ he told newsGP.

‘In my clinical practice caring for older adults, I regularly encounter the negative impacts of polypharmacy – such as increased falls, confusion, and reduced quality of life.
 
‘These guidelines can help clinicians identify and safely discontinue medications that no longer offer clear benefits.

‘Deprescribing is fundamentally about patient-centred care. It prioritises the individual’s goals, values, and preferences, which often evolve over time.
 
‘By systematically reviewing and adjusting medication regimens, we can significantly enhance the quality of life and functional independence of older adults.’

The draft guideline includes recommendations for health professionals to have deprescribing conversations, as well as to support improved decision-making and safer prescribing practices.
 
Professor Dimity Pond, a GP with a special interest in aged care, is another co-author.
 
She said older people often end up on long lists of medications prescribed by a range of healthcare professionals.
 
‘In part, this is because multimorbidity is the norm in older people,’ she said.
 
‘In part it is because each condition is often handled by a sub specialist in that area who adheres to treating guidelines developed without consideration of other morbidities.
 
‘This is expensive for the system and may be dangerous for the patient if drug interactions occur or side-effects multiply.’
 
For Professor Pond, the guideline will be particularly useful for GPs and geriatricians who may not be familiar with deprescribing processes for specialised medications prescribed by others.
 
‘This guideline fills that gap and enables deprescription in consultation with the relevant specialist using processes researched and identified in this handbook,’ she said.
 
Research published in the British Medical Journal last year suggested that 71% of clinical practice guidelines do not contain any advice on deprescribing. 
 
Looking at guidelines published across most of the world in the last decade, the analysis found even those that do contain deprescribing recommendations did not include detailed information, highlighting a need for greater clarity and specificity.
 
RACGP Vice President and WA Chair Dr Ramya Raman said the draft guideline will build on the detail of the college’s Silver Book, which is aimed at GPs caring for older people and includes information on deprescribing.
 
‘I expect the deprescribing guidelines will provide welcome evidence-based recommendations for both GPs and non-GP specialists to support clinical decision-making in safely reducing or ceasing medications,’ she said.
 
‘This draft guideline is detailed and will be helpful as a reference alongside consultation with other members of the patient’s multidisciplinary care team.’
 
According to the Silver Book authors, ‘supervised withdrawal of unnecessary medicines is safe and may improve quality of life in older people’. They also advise that optimal medication management requires a multidisciplinary approach.
 
The RACGP says it will make a submission with feedback on the draft guideline.
 
The full guideline document is available here and public consultation is open until 31 May, 2025.
 
Log in below to join the conversation.

aged care deprescribing medications polypharmacy