Impact of pharmacist-led deprescribing interventions on medication related outcomes among older adults: a systematic review and meta-analysis

Abstract

BACKGROUND: Older adults usually experience polypharmacy which increases their risk of adverse drug events, drug-drug interactions, and medication non-adherence. Clinical pharmacists, with specialized expertise in pharmacotherapy, are capable of engaging in deprescribing interventions aimed at reducing potentially inappropriate medications and overall medication burden. However, the overall impact of these pharmacist-led strategies remains unclear due to heterogeneity in study designs, settings, and outcomes. OBJECTIVES: The aim of this study was to assess the impact of pharmacist-led deprescribing interventions among older adults across different settings. METHODS: We searched PubMed/MEDLINE, ScienceDirect, the Cochrane Library, and Google Scholar for English language randomized controlled trials and high-quality nonrandomized studies published from January 2015 onward, comparing pharmacist-led deprescribing interventions to usual care in any setting (community, outpatient, hospital, or long-term care). Primary outcomes were mean change in total number of medications per patient and the proportion of patients achieving effective deprescribing (discontinuation of ≥ 1 PIM or ≥ 0.5 reduction in a drug burden index). RESULTS: Seven studies (five RCTs, two non-randomized) encompassing 3,607 older adults met inclusion criteria. The pooled mean difference (MD) in total medications at last follow-up favored intervention by - 0.55 medications (95% CI - 2.17 to 1.07; I² = 83.1%), and the pooled risk ratio (RR) for effective deprescribing was 1.85 (95% CI 0.63-5.45; I² = 73.5%), though neither reached statistical significance. Secondary outcomes indicated improvements in medication burden indices without increased adverse events. CONCLUSION: Pharmacist-led deprescribing reduces inappropriate medication use in targeted settings, while pooled effects on total medication count and hard clinical outcomes remain uncertain. Variability in study designs and outcomes underscores the need for larger, thoroughly designed trials with standardized protocols, longer follow-up, and comprehensive evaluations of clinical, economic, and patient-reported outcomes to establish scalable, sustainable deprescribing practices across diverse healthcare settings. PROTOCOL REGISTRATION: The protocol for this systematic review was registered in International Prospective Register of Systematic Reviews (PROSPERO identifier: CRD420251072072).