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First do no harm: a real need to deprescribe in older patients

Deliberate yet judicious deprescribing has considerable potential to relieve unnecessary medication-related suffering and disability in vulnerable older populations. Polypharmacy — variously defined as more than five or up to 10 or more medications taken regularly per individual — is common among older people (defined here as those aged 65 years or over). Depending on the circumstances, including why and how drugs are being administered, polypharmacy can be appropriate (potential benefits outweigh potential harms) or inappropriate (potential harms outweigh potential benefits).

While many older people benefit immeasurably from multiple drugs, many others suffer adverse drug events (ADEs). In Australia, one in four community-living older people are hospitalised for medication-related problems over a 5-year period1 and 15% of older patients attending general practice report an ADE over the previous 6 months.2 At least a quarter of these ADEs are potentially preventable.2 Up to 30% of hospital admissions for patients over 75 years of age are medication related, and up to three-quarters are potentially preventable.3 Up to 40% of people living in either residential care4 or the community5 are prescribed potentially inappropriate medications. In both…