These clinical guidelines follow the NHMRC Guideline Development Methodology and the Appraisal of Guidelines for Research & Evaluation (AGREE) II Instrument and User’s Manual.(10, 11)
The PICO informing the evidence review are detailed in Table 1
| Table 1: PICO Criteria | |||
| Descriptor | Inclusion Criteria | Exclusion Criteria | |
| Population | Adults aged 65 years and older. It will not be limited by setting, cognitive function, or comorbidities. | Aged 65 years and over 65 years and older will be defined as studies where one of the following applies: The mean participant age is 65 years or older. Greater than 75% of participants are aged 65 years and older. The data from people aged 65 years and older can be extracted. | Unclear age Studies that include only moribund, terminal, or palliative participants will be excluded. |
| Intervention | Deprescribing of individual common medications* | Medication intended for regular use | Medication intended for short-term, intermittent, as required, or acute use only |
| Comparator | Continuation of the medicationOr no comparator | Continuation of the medicationNo comparisonNon-pharmacological intervention | Substitution with an alternative medication |
| Outcomes | Primary outcomesMortality Adverse drug withdrawal effects Secondary outcomesClinically relevant health-outcomes Hospital admissionClinically significant events e.g. fracture, stroke, myocardial infarctClinically relevant surrogate end points (e.g. commonly-measured surrogate end-points such as blood pressure, HbA1C)Quality of life, measured with standardised tool | Outcomes of uncertain or limited clinical relevance | |
| Setting | No limitations |
‘Common’ medication were defined as the top 100 most commonly prescribed medicines on the PBS. ’The quality of evidence for each recommendation is evaluated according to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system (high, moderate, low, or very low). Where evidence based recommendations are not possible, consensus based recommendations (developed using a modified Delphi process) are presented.
We will provide information to support decisions:
- Supporting data and report of benefits and harms of both medication continuation and medication discontinuation
- Report the balance and trade-off between the benefits and risks of medication continuation and discontinuation
Link between recommendations and evidence:
We will create evidence tables and evidence summaries for each recommendation that will explicitly link the recommendation with the evidence on which it was based:
- Where available, existing Australian guidelines or position paper recommendations will be utilised within this guideline.
- For topics that have had recent high quality systematic reviews completed by another group (e.g. Cochrane review) and the recommendations are in-line with Australian and New Zealand practices, then the other groups recommendations will be emphasised (rather than re-doing a full systematic review).