Table 1: Included study characteristics for studies deprescribing polypharmacy
| Reference | Deprescribing target | Study design | Country | Setting | Follow-up duration (months) | Number of participants enrolled | Gender male (Percentage) | Mean age of participants in years | Includes participants with dementia | Outcomes |
| Potter 2016 | Polypharmacy | Randomized controlled study | Australia | Residential Care | 12 | 95 | 48 | 84.3 | Yes | Median number of regular medicines Cognitive function Independence in activities of daily living Falls Fractures Sleep quality Bowel function Quality of life Mortality |
| Dalleur 2014 | Polypharmacy | Randomized controlled study | Belgium | Hospital | 12 | 158 | 34 | Not stated – median: 84 years | Unclear – 26 participants are described as having a “cognitive disorder.” | Proportion of potentially inappropriate medicines ceased between hospital admission and discharge Characteristics associated with discontinuation of potentially inappropriate medicines at discharge Proportion of potentially inappropriate medicines that were still discontinued 1 year after discharge Clinical significance of the STOPP-related recommendations Mortality |
| García-Gollarte 2014 | Polypharmacy | Randomized controlled study | Spain | Residential Care | 6 | 1018 | 73 | 84.4 | Yes, 1010 (99%) | STOPP/START criteria – participants with at least one item Falls Delirium, number of episodes Mortality Physician visits Emergency department visits Hospital in-patient days |
| Pitkala 2014 | Polypharmacy | Randomized controlled study | Finland | Residential Care | 12 | 227 | 29 | 82.9 | Yes | Proportion of persons using inappropriate, anticholinergic or more than two psychotropic drugs Change in the mean number of inappropriate, anticholinergic and psychotropic drugs Number of hospitalizations Ambulatory service utilization 15D HRQOL measure Mortality |
| Beer 2011 | Polypharmacy | Randomized controlled study | Australia | Residential Care Community | 3 | 44 | 32 | 81 | Unclear – mean MMSE 27 ± 2 so may include participants with mild dementia |
Short-form 36 health survey EuroQol 5-D visual analog scale Sleep quality MMSE Medication Adherence Mortality |
| Gallagher 2011 | Polypharmacy | Randomized controlled study | Ireland | Hospital | 6 | 400 | 45 | Unstated (median 74.5) | Yes |
Medicine Appropriateness Index Assessment of Underutilization index STOPP/START criteria – participants with at least one item Falls All cause mortality Duration of initial hospital stay Hospital readmission General practitioner visits |
| Gnjidic 2010 | Polypharmacy | Randomized controlled study | Australia | Community | 3 | 115 | 73 | 80.4 | No |
Frequency of use of Drug Burden Index
regularly scheduled and/or as-needed drugs
across different drug classes at baseline and prescribing change at Follow-up Impact of study intervention on prescribing change Barriers to reducing regularly scheduled Drug Burden Index drugs Mortality |
| Weber 2008 | Polypharmacy | Randomized controlled study | United States of America | Community | 15 | 620 | 21 | 76.9 | Yes |
Medication use Falls, percentage of participants who reported at least one fall Mortality |
| Allard 2001 | Polypharmacy | Randomized controlled study | Canada | Community | 12 | 503 | 17 | 80.4 | No |
Total number of potentially
inappropriate medicines per person Total number of medicines prescribed per person Number of subjects with at least one potentially inappropriate medicine Mortality |
| Campbell 1999 | Polypharmacy | Randomized controlled study | New Zealand | Community | 10 | 93 | 24 | 74.6 | No | Falls |
| Tabloski 1998 | Polypharmacy | Randomized controlled study | United States of America | Community | 1.25 | 20 | 0 | 77.5 | No |
Sleep complaints Time in bed (minutes) Sleep latency (minutes) Total sleep time (minutes) Sleep (minutes) Sleep efficiency (score) Longest Sleep Period (minutes) Number of wakes Wake After Sleep Onset (minutes) |
| Hanlon 1996 | Polypharmacy |
Randomized controlled study AND Before-and-after study (2 papers) | United States of America | Community | 12 | 207 | 61 | Unstated (median 69 years) | No |
Medicine Appropriateness Index Health-related quality of life using Short-form 36 health survey Adverse drug reactions Patient medication compliance and knowledge Adverse drug withdrawal effects Medicines associated with adverse drug withdrawal effects Predictive factors of adverse drug withdrawal effects Mortality |
| Pitkala 2001 | Polypharmacy | Pseudo- Randomized controlled study | Finland | Community | Unstated | 174 | 34 | 77 | Yes | Drug utilization |
| Salonoja 2012 | Polypharmacy | Non-randomized controlled study | Finland | Community | 48 | 591 | 11 | Unstated (minimum age 65) | No |
Number of falls in total (i.e. one
person may have had one or more falls, so can contribute more than once) Number of people falling (i.e. just if the person has fallen at least once) Risk of a fall that required medical treatment (regression – deprescribing group is reference group) |
| Muir 2001 | Polypharmacy | Non-randomized controlled study | United States of America | Hospital | 1.25 to 1.75 | 836 | 99 | 65.2 | No |
Change in medications and doses Number of admission and discharge medications by drug class Proportions of patients taking individual medications |
| Van Der Velde 2007 | Polypharmacy | Case-control Study | The Netherlands | Community | 2 | 141 | 26 | 78.4 | Unclear |
Risk of a fall during follow-up Mobility testing |
| Yeh 2013 | Polypharmacy | Prospective cohort study | Taiwan | Residential Care | 3 | 67 | 100 | 83.4 | Yes |
Clinician-Rated Anticholinergic Score MMSE Modified Bartel Index Hospital admissions Mortality |
| Garfinkel 2007 | Polypharmacy | Prospective cohort study | Israel | Hospital | 12 | 190 | 31 | 81.2 | Yes |
Successful deprescribing Mortality Admitted to acute care facility Medicine cost |
| Kroenke 1990 | Polypharmacy | Prospective cohort study | United States of America | Hospital | 6 | 79 | 59 | 72.3 | No |
Mean number of medicines Daily dose |
| Garfinkel 2010 | Polypharmacy | Before-and-after study | Israel | Community | 19.2 | 70 | 39 | 82.8 | Yes |
Symptom recurrence after
discontinuation Successful deprescribing rate Global assessment scale Cognitive function – MMSE Hospital admission Commenced recommended new medicine |
| Gerety 1993 | Polypharmacy | Before-and-after study | United States of America | Residential Care | 6 | 132 | Unstated | 70.1 | No |
Incidence and severity of adverse
drug events Incidence and severity of adverse drug withdrawal events Demographic factors associated with risk of adverse drug events and adverse drug withdrawal events. Change in medicine use |
Table 2: Included study characteristics for individual deprescribing targets
| Reference | Deprescribing target | Study design | Country | Setting | Follow-up duration (months) | Number of participants enrolled | Gender male (percentage) | Mean age of participants in years | Includes participants with dementia | Outcomes |
| Reeve 2015 | Proton pump inhibitors | Before-and-after study | Australia | Community | 6 | 6 | 33 | 70 | No | Proton pump inhibitor use Adverse drug withdrawal effects |
| Sjöblom 2008 | Insulin, oral antiglycaemic | Prospective cohort study | Sweden | Residential Care | 6 | 98 | 42 | 84.4 | No |
Glycaemic control HbA1C Clinical outcomes All cause mortality |
| Henschke 1981 | Potassium supplementation | Before-and-after study | Canada | Residential Care | 3 | 33 | 100 | 70 | No |
Potassium levels Distributions of erythrocyte K values |
| Yedidya 2012 | Clopidogrel | Randomized controlled study | Israel | Community | 24 | 20.00 | 75 | 65.9 | No |
Hematological endpoints (surrogate
endpoints) e.g. platelet aggregation Clinical events (bleeding or Ischemic) |
| Sambu 2011 | Clopidogrel | Before-and-after study | England | Community | 1 | 38 | 82 | 65.9 | No |
Clinical events Concomitant medical treatment and platelet reactivity Thromboxane B2 levels Adenosine diphosphate (ADP)-induced platelet aggregation Arachidonic acid-induced platelet aggregation Inflammatory biomarkers |
| Derogar 2013 | Aspirin | Retrospective cohort study | Sweden | Hospital | 24 | 118 | 60 | unstated (median 79) | No |
Death Acute cardiovascular events Hospitalization due to endoscopically verified Recurrent peptic ulcer bleeding |
| Patel 2013 | Rivaroxaban | Randomized controlled study | International | Community | 0.1 to 1 | 5882 | unstated | Unstated (median 73) | No |
Stroke, non-central nervous system,
embolism, myocardial infarction, or vascular death Major bleeding |
| Dawson 1999 | Cilostazol, pentoxifylline | Randomized controlled study | United States of America | Community | 7 | 60 | 65 | 66.4 | No |
Maximal walking distance Pain-free walking distance Resting Doppler limb pressures Safety and tolerability of the study medications were assessed for all subjects with clinical laboratory monitoring, electrocardiography, physical examination, vital signs, and adverse event reporting |
| Moonen 2015 | Antihypertensives | Randomized controlled study | Netherlands | Community | 4 | 385 | 46 | 81.1 | Yes | Systolic blood pressure Diastolic blood pressure Cognition Depression Functional status Quality of life |
| Jondeau 2009 | Antihypertensives (Beta-blocker) | Randomized controlled study | France | Hospital | 3 | 169 | 57 | 72.3 | No |
Dyspnea and general well-being BNP plasma levels Duration of hospitalizations Re-hospitalization rate Death rate Successful deprescribing |
| Hearing 1999 | Antihypertensives (atenolol) | Randomized controlled study | England | Community | 0.5 | 37 | 38 | 72.3 | No | Cognitive Drug Research Computerized Cognitive Assessment System |
| Espeland & Kostis 1998 | Antihypertensive | Randomized controlled study | United States of America | Community | 26.7 | 975 | 48 | 65.8 | No |
Predictors of successful
deprescribing Cardiovascular events Reported rates of cardiovascular events The probability of remaining normotensive without receiving antihypertensive medication |
| Nelson 2002 | Antihypertensive | Case-control study AND Before-and-after study (2 papers) | Australia | Community | 12 | 6833 | 44 | 71.9 | No |
Remaining normotensive Characteristics predictive of remaining normotensive |
| Lernfelt 1990 | Antihypertensive | Historical cohort study | Sweden | Community | 48 | 25 | 40 | Unstated (inclusion criteria mean that participants were all over 70 years) | No |
Blood pressure Successful deprescribing Left ventricular function and other surrogate measures |
| Hajjar 2013 | Antihypertensive | Before-and-after study | United States of America | Community | 0.75 | 53 | 36 | 71 | No | Adverse drug withdrawal effects Blood pressure (systolic and diastolic) |
| Jimenez-Candil 2005 | Antihypertensive (ACEI) | Before-and-after study | Spain | Community | 3 | 22 | 59 | 71.6 | No |
Exercise-induced blood pressure response (fall or failure to rise) Exercise duration Haemodynamic response |
| Alsop 2001 | Antihypertensive | Before-and-after study | England | Community | 30 | 338 | 25 | 80 | No |
Symptom improvement Successful deprescribing |
| Ekbom 1994 | Antihypertensive | Before-and-after study | Sweden | Community | 60 | 333 | 32 | 75.2 | No |
Probability of restarting
antihypertensive therapy Total mortality Cardiovascular events Comparison of death hazard between the three states and that of the normal Swedish population, matched for age and sex Major reasons for restarting treatment |
| Fotherby 1994 | Antihypertensive | Before-and-after study | England | Community Hospital | 12 | 78 | 63 | 76 | No | Successful deprescribing |
| Nadal 1994 | Antihypertensive | Before-and-after study | Sweden | Community | 36 | 86 | 38 | 74 | No |
Reverted to hypertensive during the one
month washout period Successful deprescribing from one month to 36 months Differences in those that restarted and those who were deprescribed successfully Serious adverse events |
| Hansen 1983 | Antihypertensive | Before-and-after study | Denmark | Community | 12 | 169 | unstated | 75 | No | Successful deprescribing Screening normotensive |
| Fair 1990 | Digoxin | Before-and-after study | Scotland | Community | 4- 11 | 32 | 28 | 74.2 | No |
Successful deprescribing Adverse drug withdrawal events Digoxin dose when reinstated |
| Macarthur 1990 | Digoxin | Before-and-after study | Canada | Residential Care | 16 | 14 | 0 | 82.5 | No |
Successful deprescribing Clinical outcomes |
| Wilkins 1985 | Digoxin | Before-and-after study | United States of America | Residential Care | Unstated | 19 | 16 | 84.9 | Unclear |
Clinical outcomes after deprescribing Pulse Weight |
| Daly 1983 | Digoxin | Before-and-after study | Scotland | Community | 1 | 15 | 40 | 74.7 | No | Successful deprescribing New incidences of heart failure New or increase prescription of diuretics |
| Sommers 1981 | Digoxin | Before-and-after study | South Africa | Community | 15 | 20 | 30 | 73 | No |
Clinical evaluation Successful deprescribing |
| Fonrose 1974 | Digoxin | Before-and-after study | United States of America | Residential Care | Unstated | 31 | 10 | 83 | Unclear |
Successful deprescribing Adverse events Death |
| van Kraaij 2000 | Diuretic | Randomized controlled study | The Netherlands | Community | Unstated | 32 | 47 | 75 | No |
Successful deprescribing Changes at three months Blood pressure Temporary difference |
| Walma 1997 | Diuretic | Randomized controlled study | The Netherlands | Community | 6 | 202 | 25 | 76 | No |
Successful deprescribing Changes in systolic and diastolic blood pressures |
| De Jonge 1994 | Diuretic | Randomized controlled study | The Netherlands | Community | 1.5 | 63 | 13 | unstated (minimum age 65) | No |
Ankle edema Successful deprescribing Determinants of edema after deprescribing |
| Myers 1982 | Diuretic | Randomized controlled study | Canada | Residential Care | 12 | 77 | 78 |
Females: 84.5 Males: 79.1 | Yes |
Hypertension Congestive heart failure Biochemical abnormalities Weight Ankle edema Events |
| Burr 1977 | Diuretics & potassium supplementation | Randomized controlled study | United States of America | Hospital | 3 | 106 | 12 | 80.5 | No |
Blood pressure and pulse Distribution of plasma potassium levels Distribution of plasma urea levels Changes in ankle edema |
| Straand 1993 | Diuretic | Before-and-after study | Norway | Community | 6 | 33 | 24 | 82 | No | Successful deprescribing |
| Walma 1993 | Diuretic | Before-and-after study | The Netherlands | Community | 6 | 15 | 27 | 78 | No |
Successful deprescribing Blood pressure Heart failure score Weight Ankle circumference |
| George 2003 | Nitrates | Randomized controlled study | Israel | Community | 3 | 120 | 55 | 65.5 | No |
Successful deprescribing Relapse Characteristics of participants who relapsed Cardiovascular events Death |
| Jackson 2005 | Nitrates | Before-and-after study | England | Community | 3 | 55 | unstated | 65.2 | No |
Successful deprescribing Exacerbation of angina Five-item Sexual Health Inventory for Men |
| Kutner 2015 | Statin | Randomized controlled study | United States of America | Community | 12 | 381 | 55 | 74.8 | Yes |
Survival at 60 days
Time to death
Time to first cardiovascular-related
event
Cost savings
Quality of life
Symptoms
Number of non-statin medications Likelihood to receive the recommended care |
| Lin 2014 | Benign prostatic hypertrophy treatment (alpha-blocker and 5-alpha–reductase inhibitor therapy) | Randomized controlled study | Taiwan | Community | 12 | 240 | 0 | 78.3 and 74.3 | No | Successful deprescribing Progression of benign prostatic hypertrophy symptoms Progression of lower urinary tract symptoms Maximum flow rate (Qmax) Volume International Prostate Symptom Score –Storage subscore International Prostate Symptom Score –Voiding subscore International Prostate Symptom Score –Total score quality of life Postvoid residual urine Total prostate volume Transition zone index Serum prostate-specific antigen |
| Coll 2000 | Levothyroxine | Before-and-after study | United States of America | Residential Care | 3 | 22 | 9 | 78 | No |
Successful deprescribing Adverse effects |
| Cibere 2004 | Glucosamine | Randomized controlled study | Canada | Community | 6 | 137 | 44 | 65 | No |
Disease flare Function measured using Western Ontario and McMaster Universities Osteoarthritis Index Quality of life measured using EuroQol 5-D utility and visual analog scale |
| Esselinckx 1977 | Prednisolone | Before-and-after study | England | Community | Unstated | 18 | 39 | 69 | No |
Successful deprescribing after abrupt
discontinuation Laboratory results after gradual discontinuation Laboratory outcomes after abrupt discontinuation Successful deprescribing after titrated withdrawal Adverse effects |
| Black 2012 | Bisphosphonates (zoledronic acid) | Randomized controlled study | International | Community | 60 | 1099 | 0 | 73.7 | No |
bone mass density in femoral neck –
percentage change bone mass density of spine and total hip Changes from pretreatment levels over 6 years (baseline to 6 years) Biochemical bone turnover markers Fractures (clinical, non-vertebral, clinical spine, and morphometric vertebral) Adverse events |
| Black 2006 | Bisphosphonates (alendronate) | Randomized controlled study | United States of America | Community | 36 | 1233 | 0 | 75.5 | No |
Change in bone mineral density for
duration of deprescribing Biochemical Markers of Bone Turnover Incidence of Fracture Histomorphometry/Micro–Computed TomographyHistomorphometric Findings From Iliac Crest Biopsies Adverse Events Antifracture efficacy of continued alendronate in subgroups defined by femoral neck T-score and vertebral fracture status |
| Watts 2008 | Bisphosphonate (risedronate) | Non-randomized controlled study | United States of America | Community | 12 | 759 | 0 | 68.5 | No | bone mass density of the femoral neck bone mass density of the lumbar spine Urine NTX Serum bone-specific alkaline phosphatase New vertebral fractures New non-vertebral fractures |
| da Silva 2011 | Bisphosphonates (alendronate) | Prospective cohort study | Brazil | Community | 12 | 90 | 0 | 71.0 | No |
Bone mass density Fractures Bone turnover markers Parathyroid and calcium and vitamin D levels |
| Eastell 2011 | Bisphosphonates (risedronate) | Prospective cohort study | 80 European and Australian centers | Community | 12 | 61 | 0 | 66.9 | No | Adverse events Bone mass density change from baseline Bone markers change from baseline |
| OrrWalker 1997 | Bisphosphonates (Pamidronate) | Before-and-after study | New Zealand | Community | 48 | 22 | 0 | 65.9 | No | Change in bone mass density |
| Leder 2009 | Teriparatide | Two single arm studies (without concurrent control group) | United States of America | Community | 42 | 65 | 54 | 65 | No | bone mass density (PA spine, femoral neck, total hip, and trabecular spine) Biochemical markers of bone turnover |
| Radford 2014 | Calcium supplement | Non-randomized controlled study | New Zealand | Community | 60 | 1408 | 100 | 74.1 | No | Death Any fracture Osteoporotic fracture Forearm fracture Vertebral fracture Hip fracture Myocardial infarction Stroke Bone mass density |
| Dawson-Hughes 2000 | Calcium, vitamin D | Randomized controlled study | United States of America | Community | 60 | 325 | 39 | 74 | No |
Vertebral fractures Non-vertebral fractures bone mass density testing Laboratory measurements |
| Gallagher 2002 | Calcitriol and/or hormone replacement therapy | Randomized controlled study | United States of America | Community | 6 | 489 | 0 | 71.8 | No | Mean bone mass density for spine, total body, total femur, total hip, trochanter Urinary N-telopeptides Serum osteocalcin Serum parathyroid hormone Serum 25OHOD levels |
| Tariot 1999 | Carbamazepine | Randomized controlled study | United States of America | Community | 0.75 | 51 | unstated | 86 | Yes |
Brief Psychiatric Rating Scale Physical Self-Maintenance Scale Clinical Global Impressions scale MMSE Adverse effects |
| Drimer 2004 | Anticholinergic medicine (biperiden) | Before-and-after study | Israel | Hospital | 0.3 | 27 | 48 | 65.7 | No |
Adverse drug withdrawal effects Mental status Alzheimer’s Disease Assessment Scale–Cognitive sub-scale results |
| Tse 2008 | Levodopa | Randomized controlled study | United States of America | Residential Care | 1 | 11 | 36 | 82 | Yes |
MMSE Unified Parkinson’s Disease Rating Scale Nursing Assistant Behavioral Detection Form Hoehn and Yahr staging scale Motor and Behavioral Deterioration as Assessed by the Blinded Floor Physician |
| Cunnington 2012 | Dopamine agonist | Case-control study | Scotland | Community | Unstated | 46 | 67 | 70 | No | Presence of Dopamine Agonist Withdrawal Syndrome |
| Hauser 2000 | Levodopa/carbidopa and bromocriptine | Before-and-after study | United States of America | Community | 0.5 | 31 | unstated | 69.2 | No | Adverse drug withdrawal effects Unified Parkinson’s Disease Rating Scale |
| Hardy 1997 | Lithium | Randomized controlled study | Canada | Community | 24 | 12 | 17 | 79 | No | Serum creatinine Serum thyroid-stimulating hormone Mean composite side effect symptom scores Depression |
| Fahy 2001 | Lithium | Case-control study | Ireland | Community | 19.5 | 21 | 5 | 77.6 | No |
Time to relapse or follow-up time Response to reintroduction of therapy |
| Flint 1999 | Lithium, antidepressants | Before-and-after study | Canada | Community | 24 | 21 | unstated | 74.4 | No |
Depression recurrence Predictors of recurrence Response to reintroduction of therapy |
| Bergh 2012 | Antidepressants | Randomized controlled study | Norway | Residential care | 6 | 128 | 25 | 85.3 | Yes | Cornell scale Neuropsychiatric Index Quality of life-Alzheimer’s disease scale Unified Parkinson’s disease rating scale Severe impairment battery Lawton and Brody’s physical self-maintenance scale Weight Change in number of psychotropic drugs taken Oxazepam (mg)/day in last 21 days Change in number of falls per day in the last 21 days Clinical dementia rating Death |
| Ulfvarson 2003 | Antidepressants | Randomized controlled study | Sweden | Residential Care | 12 | 70 | 33 | 84.1 | No |
Montgomery Asberg depression rating
scale Global assessment of functioning Health index Symptom assessment form Symptoms of side effects of Selective Serotonin Reuptake Inhibitor (SSRI) drug treatment Death at one year |
| Bergh 2008 | Antipsychotics and antidepressants | Before-and-after study | Norway | Residential care | 6 | 23 | 8 | 84.1 | No | Neuropsychiatric Index Cornell’s Depression Score Severe Impairment Battery Unified Parkinson Disease Rating Scale |
| Lindström 2007 | Antidepressants | Before-and-after study | Sweden | Residential Care | Unclear, perhaps up to 28 weeks | 119 | unstated |
Unstated (Age group 65 to 74 years: 9
participants Age group 75 to 84 years: 45 participants Age group 85 years and over: 65 participants) | Yes |
Successful deprescribing Predictors of successful deprescribing assessed using the Montgomery Asberg Depression Rating Scale |
| Devanand 2012 | Antipsychotic (risperidone) | Randomized controlled study | United States of America | Community and Residential care | 11 | 110 | 40 | 80.3 | Yes |
Adverse events Relapse Simpson–Angus Abnormal Involuntary Movement Scale Treatment Emergent Symptoms Scale Alzheimer’s Disease Assessment Scale – cognitive Physical Self-Maintenance Scale MMSE scores Increases in body weight |
| Devanand 2011 | Typical antipsychotic | Randomized controlled study | United States of America | Community | 10 | 44 | 43 | 75.0 | Yes |
Relapse measured by Clinical Global
Impression-Change Behavior measured by MMSE, modified Blessed Functional Activity Scale Death Brief Psychiatric Rating Scale Unified Parkinson’s Disease Rating Scale |
| Ballard 2008 & Ballard 2009 | Antipsychotics | Randomized controlled study | England and Scotland | Residential Care | 3 | 100 | 19 | 83.6 | Yes |
Survival Successful deprescribing Total Severe Impairment Battery score (change from baseline to 6 mo) Standardized MMSE FAS test of Verbal Fluency Bristol Activities of Daily Living Scale Sheffield Test for Acquired Language Disorders Neuropsychiatric Index Modified Unified Parkinson’s Disease Rating Scale Clinician’s Global Impression of Change Post-Hoc Additional Exploratory Sensitivity Analysis |
| Ballard 2004 | Antipsychotics | Randomized controlled study | England | Residential Care | 12 | 165 | 24 | 84.8 | Yes |
Quality of life (measured as
differences in change in behavioral
symptoms) Change in Neuropsychiatric Inventory |
| Ruths 2004 | Antipsychotic | Randomized controlled study | Norway | Residential Care | 1 | 30 | 20 | 83.4 | Yes |
Medication use Sleep / Wake Activity Neuropsychiatric Inventory Successful deprescribing Deaths |
| Van Reekum 2002 | Antipsychotic | Randomized controlled study | Canada | Residential Care | 6 | 34 | 50 | 84.4 | Yes |
Behavioral assessed by the Behavioral
Pathology in Alzheimer’s Disease Rating Scale, Neuropsychiatric Inventory,
Retrospective Overt Aggression Scale Cognitive Function assessed by the MMSE and Mattis Dementia Rating Scale Functional level assessed by the Blessed Dementia Scale – activities of daily living and motivational behavior sub-scale Extrapyramidal symptoms assessed by the Extrapyramidal Symptom Rating Scale Clinical global impression scale Behavioral deteriorations leading to study withdrawal Lorazepam use as required |
| Bridges-Parlet 1997 | Antipsychotic | Randomized controlled study | United States of America | Residential Care | 1 | 36 | 19 | 81.7 | Yes |
Episodes of Physically Aggressive
Behavior Adverse drug withdrawal events |
| Somani 1996 | Typical antipsychotic | Non-randomized controlled study | United States of America | Residential Care | 8 | 57 | 25 | 85 | Yes |
Presence of Dyskinesias Severity Withdrawal dyskinesias Reversible of withdrawal dyskinesias Behavioral relapse Falls Adverse drug withdrawal events Successful deprescribing |
| Thapa 1994 | Typical antipsychotic | Non-randomized controlled study | United States of America | Residential Care | 6 | 334 | 22 | 82.6 | Yes |
Psychotropic medicine use Behavioral problems assessed using the nursing home Behavior Problem Scale Psychiatric symptoms assessed using the Brief Psychiatric Rating Scale Function Activities of Daily Living assessed using Lawton’s Physical Self-Maintenance Scale Cognition assessed using MMSE Geriatric Depression Scale Abnormal Involuntary Movement Scale |
| Horwitz 1995 | Typical antipsychotic | Comparative study with two single arms | United States of America | Hospital | 12 | 53 | 17 | 82.7 | Yes |
Discontinued antipsychotic MMSE Sandoz Clinical Assessment Geriatric scale Overt Aggression Scale Functional status measured by the Minimum Data Set Plus of the New York State Department of Health Psychotic symptoms as judged by a psychiatric nurse-specialist Quantified Neurological Exam Abnormal Involuntary Movement Scale |
| Azermai 2013 | Antipsychotics | Before-and-after study | Belgium | Hospital | 1 | 40 | 53 | 84 | Yes |
Successful deprescribing Neuropsychiatric Index Possible adverse drug withdrawal effects |
| Fernandez 2005 | Atypical antipsychotic | Before-and-after study | United States of America | Community | Unstated | 6 | 67 | 78 | No | Relapse |
| Cohen-Mansfield 1999 | Benzodiazepine, typical antipsychotics | Randomized controlled study | United States of America | Residential Care | 5 | 58 | 26 | 86 | Yes |
Brief Psychiatric Rating Scale Mansfield Agitation Inventory Function Adverse effects Global Impression Accuracy of staff prediction as to whether the withdrawal would be successful |
| Tannenbaum 2014 | Benzodiazepine | Randomized controlled study | Canada | Community | 6 | 303 | 31 | 75.0 | No | Successful deprescribing Adverse drug withdrawal effects |
| Curran 2003 | Benzodiazepine | Randomized controlled study | England | Community | 12 | 138 | 29 | 77 | No |
Successfully deprescribing Cognitive and psychomotor tests Benzodiazepine withdrawal scale visual analog scalesGeriatric Depression Scale Mood factors Health-related quality of life – sub-scales of the Medical Outcomes Study Short-form 36 questionnaire |
| Petrovic 2002 | Benzodiazepine | Randomized controlled study | Belgium | Hospital | 12 | 40 | 33 | 81 | No |
Successful deprescribing Pittsburgh Sleep Quality Index score Benzodiazepine Withdrawal Symptom Questionnaire |
| Habraken 1997 | Benzodiazepine | Randomized controlled study | Belgium | Residential Care | 12 | 55 | 18 | 84 | No |
Level of daily functioning Adverse drug withdrawal effects |
| Tham 1989 | Benzodiazepine | Randomized controlled study | Ireland | Hospital | Unstated | 36 | 14 | 81.7 | Unclear |
Hours of sleep Number of times awake |
| Salzman 1992 | Benzodiazepine | Prospective cohort study | United States of America | Residential Care | 12 | 25 | 20 | 83 | Yes |
Memory Dementia Mood Assessment Scale to measure changes in sleep and affect (depression and anxiety) Successful deprescribing |
| Puustinen 2014 | Benzodiazepine | Historical cohort study | Finland | Community | 6 | 89 | 34 | 66.7 | No | Cognitive performance using the computerized test battery of attention, vigilance and controlled psychomotor processing |
| Tsunoda 2010 | Benzodiazepine | Before-and-after study | Japan | Residential Care | 2 | 30 | 57 | 79.1 | Yes |
Stability of body Neuropsychological status Critical Flicker Fusion Test Leeds Sleep Evaluation Questionnaire |
| Gaudig 2011 | Anticholinesterase inhibitors (Galantamine) | Randomized controlled study | United States of America | Community | 1.5 | 798 | 11 | 77.9 | Yes |
Alzheimer’s Disease Assessment Scale
using the 11-item cognitive sub-scale Safety and tolerability assessments included adverse event monitoring Physical examinations and laboratory testing |
| Scarpini 2011 | Anticholinesterase inhibitors (galantamine) | Randomized controlled study | Italy | Community | 36 | 139 | 40 | 74.5 | Yes |
Drop outs Adverse drug events |
| Minett 2003 | Anticholinesterase inhibitors (donepezil) | Comparative study with two single arms | England | Community | 7.5 | 24 | unstated | 81.0 | Yes | Clinical outcomes |
| Rice 2000 | Prednisolone | Randomized controlled study | United States of America | Community | 6 | 38 | 100 | 72 | No |
Average number of chronic obstructive
pulmonary disease exacerbations Average daily systemic corticosteroid dose Dyspnea index Health-related quality of life Spirometric results Changes in body weight Adverse drug withdrawal effects – symptoms of steroid withdrawal |
| Adams 2009 | Tiotropium, inhaled | Non-randomized controlled study | International | Community | 12 | 921 | 65 | 65 | No |
Medicine use at three weeks after
deprescribing Dyspnea Peak Expiratory Flow Rate (morning and evening) Health-related quality of life measured using the St George’s Respiratory Questionnaire |
| Borrill 2009 | Fluticasone and salmeterol, inhaled | Randomized controlled study | England | Community | 1.5 | 14 | unstated | 65.0 | No |
Exacerbations causing dropouts Forced expiratory volume in one second Sputum neutrophil percentage |
| Choudhury 2007 | Inhaled corticosteroids | Randomized controlled study | England | Community | 12 | 260 | 52 | 67.6 | No |
chronic obstructive pulmonary disease
exacerbation frequency Time to first exacerbation Reported symptoms Peak expiratory flow rate Reliever inhaler use Return to usual steroid inhaler Lung function Health-related quality of life – St George’s respiratory questionnaire – EuroQol 5-D total and visual analog scale Adverse effects |
| O’Brien 2001 | Inhaled corticosteroids | Randomized controlled study | United States of America | Community | 3 | 24 | 100 | 66.9 | No |
Exacerbations Chronic Respiratory Disease Questionnaire |
| Jarad 1999 | Inhaled corticosteroids | Prospective cohort study | England | Community | 2 | 272 | 15 | 66 | No | Exacerbations |
| Jampel 2014 | Intraocular pressure-lowering medicine | Non-randomized study | United States | Community | 0.2 to 1 | 603 | 55 | 70.3 | No | Intraocular pressure percentage increase Intraocular pressure percentage decrease |