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Polypharmacy and Deprescribing

Open for submissions 1st June 2022

The consequences of ageing can often result in the diagnosis of multiple chronic conditions, also known as multimorbidity leading to prescribing multiple medications (polypharmacy). Recently, it has been distinguished that sometimes polypharmacy is appropriate but most often, especially in older age, a medication that was at one point needed may become less needed or unsafe. It is estimated that more than 50% of older people are prescribed at least one medication with more harm than benefit. Inappropriate polypharmacy is associated with significant poor health outcomes such as injurious falls, cognitive impairment, hospitalization, and death, and can lead to wasteful healthcare expenditure.

Optimisation of medication prescribing has become a major public-health issue worldwide, particularly in older people, and the reduction and prevention of medication-induced harm is now classified as one of global health priorities of the World Health Organisation (WHO). Deprescribing, the process of withdrawing medications, under the supervision of a healthcare practitioner, which may no longer be of benefit or may be causing harm, may be a solution to polypharmacy, but is often hard to initiate and maintain. There has been an increasing body of research around deprescribing of medications in older people over the last 15 years. Yet, there is still a lack of a common understanding of what are the best practices or approaches for implementing deprescribing in different cultures, healthcare systems, and clinical settings. This is particularly important, as deprescribing requires complex changes to established patterns of behaviour at the individual, organisational, and systems levels. Effective deprescribing should be a patient-centred approach that involves participation by patients and/or relatives and carers, good prescriber/patient relationships and communication, and shared decision making.

Within this collection at BMC Geriatrics, we are interested in attracting a wide range of submissions relating to polypharmacy and deprescribing to address the current gaps and challenges in research and implementation in clinical practice. The span of articles may be preclinical and clinical studies, to epidemiological and implementation research and strategies.

Definition of Polypharmacy

  • What’s the new ‘norm’ in polypharmacy? ≥5 medications? ≥10 medications? 
  • Challenging the previously defined definitions.
  • How to define inappropriate polypharmacy?
  • Medication related problems in various settings e.g. hospital, community, residential aged care settings 
  • New harms of polypharmacy previously undefined?

Patient-focused interventions

  • Patient involvement in shared decision about deprescribing (tools, digital apps, barriers and facilitators, codesign strategies and interventions)
  • Patients and carers decision making aids for deprescribing 
  • The role of caregivers in the process of deprescribing/medicine optimisation 
  • Patient and caregiver-related outcomes relevant to deprescribing/medicine optimisationPatient/carers views vs. healthcare practitioner views 
  • How deprescribing is communicated to the most vulnerable people (i.e. patients with learning disability, limited health literacy, cognitive impairment, etc.)
  • Polypharmacy and deprescribing at end of life (prevalence, management, barriers/facilitators…etc)

Implementation research

  • What works or does not work in relation to implementing deprescribing/medicine optimisation in clinical practice
  • The role and value of multidisciplinary team involvement in deprescribing 
  • The use of technology to assist implementation (e,g. clinical decision support software/apps)
  • Innovative models of practices of implementation of deprescribing in different contexts and settings
  • What makes a sustainable implementation?
  • Policies and guidelines to support deprescribing.

Effectiveness and safety of deprescribing

  • Effectiveness and costeffectiveness of deprescribing/medicine optimisation interventions as a standalone intervention or part of multifactorial interventions
  • Safety of deprescribing/medicine optimisation interventions 
  • Ethical and legal implications around stopping medications 
  • The effectiveness, cost effectiveness and safety of deprescribing specific classes of drugs (e.g. fallincreasing drugs, opioids, antipsychotics, anticholinergics,…etc)
  • Tools, algorithms, guidelines and policies to facilitate deprescribing/medicine optimisation of specific classes of drugsEffect of deprescribing/medicine optimisation on geriatric syndromes (i.e. frailty, sarcopenia, falls, …etc)

Dr Kinda Ibrahim

Dr Kinda Ibrahim is a Pharmacist and Senior Lecturer, working in Academic Geriatric Medicine at the University of Southampton. She is also the deputy lead for the NIHR Wessex Applied Research Collaboration (ARC) Ageing and Dementia Theme and the ARC Wessex Associate Lead for Career Development. Kinda’s research is focused on Medicine Optimisation and Deprescribing among older patients, with a specific focus on those living with frailty who are taking multiple medications. She co-chairs the Network for European Researchers in Deprescribing (NERD) steering committee and is a key member of the joint AHSN/ARC Wessex Medicine Optimisation network and the European Geriatric Medicine Society (EUGMS) Polypharmacy Special Interest Group which bring together national and international researchers interested in deprescribing.

Dr Lisa Kouladjian O’Donnell

Dr Lisa Kouladjian O’Donnell is a Research Fellow in Geriatric Pharmacotherapy, Faculty of Medicine and Health, The University of Sydney, and Kolling Institute, Royal North Shore Hospital, New South Wales, Australia. Her research focuses on optimising quality use of medicines in older adults with particular interests in developing and translating digital health tools into clinical practice. Her work on The Drug Burden Index Calculator © and The Goal-directed Medication review Electronic Decision Support System (G-MEDSS) © are clear examples of developing medication management tools for clinicians and translational into practice.

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