Short summary

Deprescribing may be particularly relevant in older people with limited life expectancy as many medications can no longer be expected to provide clinical benefit at this point in life. With this study, we aim to test a deprescribing tool as a part of a clinical intervention in a randomized control trial among older people with limited life expectancy in primary care. The primary outcome will be quality of life.

Rationale

Polypharmacy is highly prevalent among older people. However, there is a substantial lack of evidence for the benefits of many commonly used medications among this population. Further, frail older people may have a limited life expectancy which might be shorter than the known 'time to benefit' for some drugs. Finally, goals of drug treatment for these patients may shift from preventing disease and prolonging life to reducing burden of treatment and maintaining quality of life. As such, deprescribing of unnecessary medications may be particularly relevant in older people with limited life expectancy. 

Description of the cohort

Older people with limited life expectancy in primary care. Individuals will be eligible for participation in the study if they 1) are ?80 years, 2) take ?8 different drugs, 3) have a life expectancy of <2 years (estimated by own general practitioner via 'the surprise question'), and 4) are deemed able to sign an informed consent.

Data and biological material

Primary effect outcome: Quality of life.

Primary safety outcome: Mortality.

Secondary outcomes: Cognitive function, functional level, grip strength, ability to stand and sit, number of medications discontinued, number of medication changes, admissions, health care costs, and success rate of intervention. 

Collaborating researchers and departments

Hospital Pharmacy Funen, Odense University Hospital

• Professor Anton Pottegård, PhD

Department of Geriatric Medicine, Odense University Hospital

• Associate professor Jesper Ryg, PhD

Research Unit of General Practice, Department of Public Health, University of Southern Denmark

• Professor Jens Søndergaard, PhD
• PhD student Wade Thompson
• General practitioner Palle Mark Christensen, PhD

Clinical Biochemistry and Pharmacology, Odense University Hospital

• Consultant Troels Bergmann, PhD

Clinical Pharmacology and Pharmacy, Department of Public Health, University of Southern Denmark

• Professor Jesper Hallas, PhD

Publications associated with the project

Lundby C, Graabaek T, Ryg J, Søndergaard J, Pottegård A, Nielsen DS. Health care professionals' attitudes towards deprescribing in older patients with limited life expectancy: A systematic review. Br J Clin Pharmacol. 2019;85(5):868–92. 

Lundby C, Graabæk T, Ryg J, Søndergaard J, Pottegård A, Nielsen DS. ‘… Above All, It's a Matter of? This Person's Quality of Life': Health Care Professionals' Perspectives on Deprescribing in Older Patients With Limited Life Expectancy. The Gerontologist. 2019. 

Thompson W, Lundby C, Graabaek T, Nielsen DS, Ryg J, Søndergaard J, et al. Tools for Deprescribing in Frail Older Persons and Those with Limited Life Expectancy: A Systematic Review. J Am Geriatr Soc. 2019;67(1):172–80.