ABSTRACT
INTRODUCTION: Polypharmacy, inappropriate prescribing and adverse drug reactions are frequent and important among elderly nursing home residents. Few clinical trials have evaluated systematic withdrawal of medications in nursing homes. OBJECTIVES: To compare the effect of a controlled deprescribing intervention against the usual care in elderly nursing home residents. METHODS: The present deprescribing intervention was conducted in two departments at the Shfaram Geriatric Center (Beet Alenaya). Two departments at the "Hemdat Avot" nursing home were the control arm. The intervention was a withdrawal or stepwise tapering of a target medication. The main outcome was the number of participants in whom medication withdrawal or tapering could be achieved. RESULTS: A total of 55 participants completed the intervention and follow-up. The results showed that 65.5 % of the intervention group had discontinued a medication use compared with 27% of the control group (risk difference, 73% [95%CI, 58%-85%]; intracluster correlation, 0.001; number needed to treat, 2.60). Dose reduction occurred in an additional 11%. In multivariate sub-analyses, age greater than 80 years, sex and concomitant polypharmacy (10 drugs or more per day) did not have a significant interaction effect with medication therapy discontinuation. CONCLUSION: A controlled deprescribing intervention in nursing homes was feasible and acceptable to participants. Such interventions should be further evaluated in larger randomized controlled trials.
