Plain Language Summary

The intended audience for the guidelines is healthcare professionals, which is reflected in the detailed content, clinical language, and format. This summary section of the guidelines is for members of the general public who are interested in the topic. We also plan to develop separate, consumer-friendly resources that will complement the guidelines to better meet the needs of consumers and carers. This approach will allow us to provide tailored information that is accessible and meaningful for consumers while maintaining a comprehensive, evidence-based resource for healthcare professionals.

The purpose of taking medicine is to treat or prevent illnesses or slow the progression of disease. However, a medicine that brings benefits also has the potential to cause unwanted or harmful effects. The decision to prescribe a medicine involves weighing up the potential benefits for the individual against the likelihood and potential severity of side effects. This requires a comprehensive understanding of the person’s life stage, medical history, current health status (including concomitant diagnoses), prognosis, the nature and trajectory of the condition(s) being treated, and the characteristics of the available medicines. These same principles apply when considering deprescribing, ensuring that decisions are made holistically and align with the person’s goals of care.

Prescribing should be a collaborative process that involves open communication between the healthcare professional and the expectations and preferences of the individual, their families, and/or carers. Similarly, deprescribing requires a thoughtful and structured approach, ensuring alignment with person-centred care principles. Deprescribing is an important component of rational prescribing, aimed at optimising medication regimens to ensure quality use of medicines. Deprescribing involves ongoing monitoring for benefits, harmful effects, and adverse outcomes in collaboration with the individual and their support person(s). The essence of deprescribing is to acknowledge that a person’s body (physiology), treatment preferences, and goals may change over time. To deprescribe is to simplify the medication regimen and to reduce potential risks associated with individual and combinations of medicines that may no longer be required, or when the potential risks of continuing the medicine outweigh the potential benefits.

Deprescribing is a person-centred approach that includes identifying the priorities of both the individual and the healthcare provider in relation to the treatment plan, promoting shared decision-making, determining agreed actions, communicating actions, and regular monitoring. The decision to deprescribe should be a team effort between the healthcare provider and the individual, their families or carers, with the focus on finding the most suitable solution that reflects an individual's goals, values, and preferences, considering the available research evidence, cost-effectiveness, and value-based care.

Through a person-centred approach to deprescribing, previously unrecognised health priorities and concerns may emerge. In some cases, this process may lead to the initiation of new medicines that offer potential benefits while discontinuing others that are no longer necessary.

Older people are particularly likely to benefit from deprescribing as they may be more vulnerable to the risks associated with the use of multiple medicines due to age-related changes in organ function. These risks can be further exacerbated by inadequate monitoring and a lack of ongoing, coordinated assessment of medicines, often prescribed by multiple healthcare practitioners.

However, deprescribing in practice is challenging. The purpose of this clinical practice guideline is to assist healthcare providers, especially medical practitioners, nurse practitioners, pharmacists, and other non-medical prescribers such as dental practitioners, podiatrists, and optometrists in the shared decision-making for deprescribing. Specifically, this guideline aims to provide a summary of recommendations for when, how and for whom deprescribing may be considered and offered within a shared decision-making process involving individuals, their family members, carers, or support persons to ensure decisions align with individual health goals, values, and preferences. Additionally, this guideline aims to identify monitoring requirements during the deprescribing process and address ongoing treatment needs as applicable. The recommendations and statements provided in this guideline are intended as guidance to be applied using a shared decision-making approach and are not prescriptive.

This guideline is applicable in the various settings where deprescribing decisions may be made, including primary care, hospital and residential care. It covers drug classes commonly dispensed to people aged 65 years and over, and less commonly used drug classes where there is evidence to inform deprescribing in people aged over 65 years (e.g. potassium, digoxin, nitrates, genito-urinary anticholinergics, teriparatide, bisphosphonates, levodopa, lithium, and cholinesterase inhibitors).