Inappropriate medication use and polypharmacy in older people

Inappropriate medication use and polypharmacy is widespread yet continues to receive precious little attention.12 And, despite countless people being affected, particularly in older populations, no general consensus exists on the best way to combat this insidious problem.23

In a linked study, Rieckert and colleagues (doi:10.1136/bmj.m1822) present the results of a large randomised controlled trial in primary care in Austria, Germany, Italy, and the United Kingdom that evaluated the performance of PRIMA-eDS (polypharmacy in chronic diseases: reduction of inappropriate medication and adverse drug events in older populations by electronic decision support), a computerised tool providing individualised evidence based recommendations on deprescribing.4 Use of this tool for patients aged 75 and older who were taking at least eight drugs each resulted in a reduction of 0.42 drugs per patient and a modest risk reduction in mortality and admission to hospital. Although the intervention had no effect on other clinical outcomes …