RACGP endorses deprescribing guideline for older people

The RACGP has given its stamp of approval to a new clinical guideline aiming to reduce the harms that can be caused by polypharmacy in older people.
 
The resource, now endorsed by the college, covers the most common medications on the Pharmaceutical Benefits Scheme used by people aged 65 and over.
 
Researchers at the University of Western Australia who led the project say the guideline also addresses the use of other medications where there is evidence to consider deprescribing in an older patient cohort.
 
Almost 40% of Australians aged 75 and above use five or more prescription medicines, according to the Australian Commission on Safety and Quality in Healthcare.
 
Other research suggests there are at least 250,000 medication-related hospital admissions each year, with around two-thirds of these potentially preventable.
 
Dr Xisco Reus, a GP and member of the guideline steering committee, describes polypharmacy among older people as ‘a significant healthcare issue’, with deprescribing a possible strategy to reduce associated harms.
 
‘We are very excited about this initiative and hopeful that it will make a real difference in clinical practice,’ he told newsGP.
 
‘Our goal is to empower GPs and other healthcare professionals with practical tools that make deprescribing safer, easier, and more effective.’
 
He said one barrier to deprescribing has been a lack of clear clinical guidelines.
 
‘Most existing guidelines are disease-specific and do not adequately address the complexity of multimorbidity seen in older adults,’ he said.
 
‘Furthermore, while there is a wealth of guidance on initiating medicines, there is limited information on when and how to safely discontinue them.’
 
As a GP, Dr Reus also recognises the value the guideline offers to GPs faced with limited consultation time.
 
‘With this in mind, we have designed these guidelines to be both easy to interpret and clinically practical, while also addressing the complex and nuanced scenarios we frequently encounter in daily practice,’ he said.
 
‘For example, consider a patient on anticoagulants who presents with frequent recurrent falls or has experienced a gastrointestinal bleed. Should the anticoagulant be deprescribed? These are the kinds of real-world challenges we aim to help clinicians navigate.’
 
The guide includes 35 medicine classes with recommendations, in-depth explanations and evidence-based guidance.
 
‘Importantly, the guidelines not only advise when and for whom deprescribing may be appropriate, but also provide practical instructions on how to monitor patients after medicines have been withdrawn to support the deprescribing process,’ Dr Reus said.
 
A draft guideline was released earlier this year for public consultation, attracting more than 300 responses, with revisions now incorporated into the final version.
 
The guideline’s lead author, pharmacist and University of Western Australia PhD candidate Amanda Quek, said a treatment that was once correct ‘may not always remain the best choice’.
 
‘Over time, health conditions, risks and personal goals can change, and for some, certain medicines may start to cause more harm than good,’ Ms Quek said.
 
‘These new deprescribing guidelines fill that gap, supporting health professionals and individuals in working together to decide when and how to safely reduce or stop medicines that are no longer needed or may be doing more harm than good.’
 
Dr Anthony Marinucci, Chair of RACGP Specific Interests Aged Care, is also a contributing author.
 
He said the new guideline provides GPs with ‘an evidence-based roadmap for safely reducing or stopping medications in older patients’.
 
‘I believe it will meaningfully improve their health outcomes,’ he told newsGP.
 
‘In my practice I regularly see older patients suffering harm from unnecessary medications – things like falls, confusion, and reduced quality of life.
 
‘Having clear deprescribing recommendations is therefore crucial for improving patient safety and wellbeing.’
 
He said the RACGP backing illustrated the quality of the guideline as well as the importance of deprescribing.
 
‘This endorsement will encourage more GPs to integrate these principles into their everyday practice,’ he said.
 
‘Ultimately, it represents a significant step towards safer and more patient-centred medication management for older Australians.’
 
The resource has also been endorsed by other healthcare organisations including the Pharmaceutical Society of Australia and the Australasian College of Pharmacy.
 
The clinical practice guidelines for deprescribing in older people are available in full at deprescibing.com.
 
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