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

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We enthusiastically welcome Scott and colleagues’ article highlighting the real need to deprescribe in older patients;1 however, we would like to emphasise the role of validated tools and medication management reviews in deprescribing.

Validated tools help clinicians identify potentially inappropriate medications. Scott et al state that medications whose benefits are outweighed by harm in most circumstances, such as potent opioids, anticholinergics and benzodiazepines, account for relatively few adverse drug events (ADEs) in Australian practice. This is potentially misleading, as it relies on practitioners or consumers recognising ADEs. Recognising ADEs is relatively simple when anticoagulants cause bleeding, but more subtle ADEs, such as functional impairment from anticholinergic and sedative medications, are often not recognised and are misattributed to ageing or multimorbidity. Therefore, validated tools for recognising high-risk medicines are an important component of medication management reviews.

We agree that input from appropriately trained (accredited) pharmacists and other health care professionals with expertise in the clinical use of medicines has been shown to be beneficial for deprescribing practice. We wish to highlight the value of medication management reviews, such as Home Medicines Review (HMR) and Residential Medication Management Review (RMMR), which involve pharmacists and general…