Plain Language Summary

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 medicine involves weighing up the potential benefits for the person against the likelihood and potential severity of side effects. It requires a comprehensive understanding of the individual's life stage, medical history, current health (including other diagnoses), prognosis, the nature of the condition, and the characteristics of the available medicines. 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.

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 more likely than younger people 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 are 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 with 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).

Healthcare professionals must actively involve individuals in shared decision-making that considers their values, preferences and treatment goals. This guideline is not a substitute for disease-specific therapeutic guidelines or non-pharmacological management resources.