Deprescribing - en ny strategi för att optimera äldre personers läkemedelsanvändning. En narrativ litteraturöversikt
DOI:
https://doi.org/10.52585/icvs.v6i1.26Abstract
Syfte: Att ge en introduktion till begreppet deprescribing och sammanfatta centrala teman i den internationella forskningen.
Metod: Narrativ litteraturöversikt baserad på sökningar i PubMed och Google Scholar, samt manuell genomgång av referenslistor.
Resultat: Deprescribing definieras som en strukturerad process för utsättning eller dosreduktion av läkemedel. Internationella studier visar att interventionen kan minska olämplig läkemedelsanvändning och total läkemedelsbörda, men effekterna på patientcentrerade utfall är begränsade och ofta osäkra. Forskningen identifierar flera hinder för implementering, bland annat tidsbrist och bristande kunskap. Få studier av deprescribing har genomförts i Sverige.
Slutsats: Deprescribing är en lovande strategi för att optimera läkemedelsanvändning hos äldre. Det behövs studier som utvärderar insatsen inom svensk vård och omsorg, inte minst för att bedöma dess praktiska genomförbarhet och kliniska nytta.
Deprescribing – a new strategy to optimise older adults’ medical use. A narrative review
Aim: To introduce the concept of deprescribing and summarise key themes in the international research literature.
Method: Narrative literature review based on searches in PubMed and Google Scholar, supplemented by manual screening of reference lists.
Results: Deprescribing is defined as a structured process for withdrawing or reducing the dose of medications. International studies show that the intervention can reduce potentially inappropriate medication use and overall medication burden, although effects on patient-centred outcomes are limited and often uncertain. Several barriers to implementation have been identified, including lack of time and insufficient knowledge. Few studies on deprescribing have been conducted in Sweden.
Conclusion: Deprescribing is a promising strategy for optimising medication use in older adults. Studies evaluating the intervention in Swedish healthcare are needed, particularly to assess its practical feasibility and clinical value.
Referenser
Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544. https://doi.org/10.1136/bmjopen-2014-006544
Anderson TS, Goyal P, Marcum ZA. Implementing a proactive deprescribing approach to prevent adverse drug events. Journal of general internal medicine. 2020;35:3694-6. https://doi.org/10.1007/s11606-020-05886-z
Burghle A, Lundby C, Ryg J, Søndergaard J, Pottegård A, Nielsen D m fl. Attitudes towards deprescribing among older adults with limited life expectancy and their relatives: a systematic review. Drugs and aging. 2020;37(7):503-20. https://doi.org/10.1007/s40266-020-00774-x
Chan B, Isenor JE, Kennie-Kaulbach N. Categorization of deprescribing communication tools: a scoping review. Basic and clinical pharmacology and toxicology. 2023;133(6):640-52. https://doi.org/10.1111/bcpt.13886
Chua S, Todd A, Reeve E, Smith SM, Fox J, Elsisi Z m fl. Deprescribing interventions in older adults: An overview of systematic reviews. Plos one 2024;19(6):e0305215. https://doi.org/10.1371/journal.pone.0305215
Cosgrave N, Frydenlund J, Beirne F, Lee S, Faez I, Cahir C m fl. Hospital admissions due to adverse drug reactions and adverse drug events in older adults: a systematic review. Age and ageing. 2025;54. https://doi.org/10.1093/ageing/afaf231
Doherty AJ, Boland P, Reed J, Clegg AJ, Stephani A-M, Williams NH m fl. Barriers and facilitators to deprescribing in primary care: A systematic review. BJGP Open. 2020;4(3): bjgpopen20X101096. https://doi.org/10.3399/bjgpopen20x101096
Farrell B, Pottie K, Rojas-Fernandez CH, Bjerre LM, Thompson W, Welch V m fl. Methodology for developing deprescribing guidelines: using evidence and GRADE to guide recommendations for deprescribing. Plos one. 2016;11(8):e0161248. https://doi.org/10.1371/journal.pone.0161248
Frisk G, Bergström H, Frankling MH, Björkhem-Bergman L m fl. Sex-differences in discontinuation of statin treatment in cancer patients the year before death. Pharmaceuticals. 2021;14(4): 368.
https://doi.org/10.3390/ph14040368
Frisk G, Szilcz M, Hedman C, Björkhem-Bergman L. Treatment with antithrombotics in the last year of life – incidence of bleeding and side effects after deprescribing. Journal of palliative medicine. 2024;27(10):1310-7. https://doi.org/10.1089/jpm.2024.0108
Greenhalgh T, Thorne S, Malterud K. Time to challenge the spurious hierarchy of systematic over narrative reviews? European journal of clinical investigation. 2018;48(6):e12931. https://doi.org/10.1111/eci.12931
Hayes KN, Niznik JD, Gnjidic D, Moriarty F, Tran N, Coe AB m fl. Evaluation of real-world evidence to assess health outcomes related to deprescribing medications in older adults: an International society for pharmacoepidemiology-endorsed systematic review of methodology. American journal of epidemiology. 2025;194(8):2431-39. https://doi.org/10.1093/aje/kwae425
Hedman C, Frisk G, Björkhem-Bergman L. Deprescribing in palliative cancer care. Life. 2022;12(5):613. https://doi.org/10.3390/life12050613
Holmes HM, Hayley DC, Alexander GC, Sachs GA. Reconsidering medication appropriateness for patients late in life. Archives of internal medicine. 2006;166:605-9. https://doi.org/10.1001/archinte.166.6.605
Holmes HM, Todd A. Evidence-based deprescribing of statins in patients with advanced illness. Jama internal medicine. 2015;175(5):701-2. https://doi.org/10.1001/jamainternmed.2015.0328
Holmes HM, Todd A. The role of patient preferences in deprescribing. Clinics in geriatric medicine. 2017;33(2):165-75. https://doi.org/10.1016/j.cger.2017.01.004
Ibrahim K, Cox NJ, Stevenson JM, Lim S, Fraser SDS, Roberts HC m fl. A systematic review of the evidence for deprescribing interventions among older people living with frailty. BMC Geriatrics. 2021;21(1):258. https://doi.org/10.1186/s12877-021-02208-8
Jepsen DB, Bergen ES, Pan J, van Poelgeest E, Osman A, Burghle A m fl. Recommendations on deprescribing of bisphosphonates in osteoporosis guidelines: a systematic review. European geriatric medicine. 2023;14:747-60. https://doi.org/10.1007/s41999-023-00820-y
Kamgang KHS, Lundby C, Szilcz M, Johnell K, Wastesson JW. Discontinuing chronic medications suggested for deprescribing in routine clinical practice: nationwide evidence from routinely collected data in Swedish older adults. Basic and clinical pharmacology and toxicology. 2025;137(3)e70093. https://doi.org/10.1111/bcpt.70093
Kua CH, Mak VSL, Huey Lee SW. Health outcomes of deprescribing interventions among older residents in nursing homes: a systematic review and meta-analysis. Journal of the American medical directors association. 2019;20(3):362–72. https://doi.org/10.1016/j.jamda.2018.10.026
Lamarre M, Marcotte M, Laurin D, Furrer D, Vedel I, Tourigny A m fl. Discontinuation of bisphosphonates in seniors: a systematic review on health outcomes. Archives of osteoporosis. 2021;16:133. https://doi.org/10.1007/s11657-021-01000-w
Langford AV, Warriach I, McEvoy AM, Karaim, E, Chand S, Turner JP m fl. What do clinical practice guidelines say about deprescribing? A scoping review. BMJ Quality and safety. 2025;34:28-39. https://doi.org/10.1136/bmjqs-2024-017101
Linsky AM, Motala A, Booth M, Lawson E, Shekelle PG. Deprescribing in community-dwelling older adults: a systematic review and meta-analysis. Jama network open. 2025;8(5):e259375. https://doi.org/10.1001/jamanetworkopen.2025.9375
Lundby C, Burghle A, Ryg J, Abuna L, Alnabhan WA, Thanikaikumaran JK m fl. Afmedicinering i danske kliniske behandlingsvejledninger. Ugeskrift for læger. 2022;184(27):V01220063.
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. Gerontologist. 2020;60(3):439-49. https://doi.org/10.1093/geront/gnz116
Läkemedelsgenomgångar. En uppföljning och utvärdering av Socialstyrelsens föreskrifter om läkemedelsgenomgångar i 11 kap (HSLF-FS 2017:37). Socialstyrelsen.
Moriarty F, Pottie K, Dolovich L, McCarthy L, Rojas-Fernandez, Farrell B. Deprescribing recommendations: an essential consideration for clinical guideline developers. Research in social and administrative pharmacy. 2019;15:806-10. https://doi.org/10.1016/j.sapharm.2018.08.014
Myndigheten för vård- och omsorgsanalys. Nationell uppföljning av hälso- och sjukvården 2022. Indikatorer på kvalitet, jämlikhet och effektivitet. Myndigheten för vård och omsorgsanalys; 2022. PM; 2022:3.
Omuya H, Nickel C, Wilson P, Chewning B. A systematic review of randomised-controlled trials on deprescribing outcomes in older adults with polypharmacy. International journal of pharmacy practice. 2023;31(4):349-68. https://doi.org/10.1093/ijpp/riad025
Paque K, Vander Stichele R, Elseviers M, Pardon K, Dilles T, Deliens L m fl. Barriers and enablers to deprescribing in people with a life-limiting disease: a systematic review. Palliative medicine. 2019;33(1):37-48. https://doi.org/10.1177/0269216318801124
van der Ploeg MA, Floriani C, Achterberg WP, Bogaerts JMK, Gussekloo J, Mooijaart SP m fl. Recommendations for (discontinuation of) statin treatment in older adults: review of guidelines. Journal of the American geriatrics society. 2020;68(2):417-25. https://doi.org/10.1111/jgs.16219
Pruskowski JA, Springer S, Thorpe CT, Klein-Fedyshin M, Handler SM. Does deprescribing improve quality of life? A systematic review of the literature. Drugs and aging. 2019;36(12):1097-110. https://doi.org/10.1007/s40266-019-00717-1
Reeve E, Gnjidic D, Long J, Hilmer S. A systematic review of the emerging definition of ”deprescribing” with network analysis: implications for future research and clinical practice. British journal of clinical pharmacology. 2015;80:1254-68. https://doi.org/10.1111/bcp.12732
Reeve E, Thompson W, Farrell B. Deprescribing: a narrative review of the evidence and practical recommendations for recognizing opportunities and taking action. European journal of internal medicine. 2017;38:3-11. https://doi.org/10.1016/j.ejim.2016.12.021
Robinson M, Mokrzecki S, Mallett AJ. Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review. NPJ aging. 2024;10:6. https://doi.org/10.1038/s41514-023-00132-2
Saeed D, Carter G, Parsons C. Interventions to improve medicines optimisation in frail older patients in secondary and acute care settings: a systematic review of randomised controlled trials and non-randomised studies. International journal of clinical pharmacology. 2022;44(1):15-26. https://doi.org/10.1007/s11096-021-01354-8
Sawan M, Reeve E, Turner J, Todd A, Steinman MA, Petrovic M m fl. A systems approach to identifying the challenges of implementing deprescribing in older adults across different health-care settings and countries: a narrative review. Expert review of clinical pharmacology. 2020;13:233-45. https://doi.org/10.1080/17512433.2020.1730812
Scott S, Clark A, Farrow C, May H, Patel M, Twigg MJ m fl. Deprescribing admission medication at a UK teaching hospital; a report on quantity and nature of activity. International journal of clinical pharmacy. 2018;40(5):991-6. https://doi.org/10.1007/s11096-018-0673-1
Socialstyrelsen. Läkemedelsgenomgångar för äldre ordinerade fem eller fler läkemedel – en vägledning för hälso- och sjukvården. Socialstyrelsen; 2013.
Thompson W, Lundby C, Graabaek T, Nielsen DS, Ryg J, Søndergaard J m fl. Tools for deprescribing in frail older persons and those with limited life expectancy: a systematic review. Journal of the American geriatrics society. 2019;67:172-80. https://doi.org/10.1111/jgs.15616
Thompson W, McDonald EG. Polypharmacy and deprescribing in older adults. Annual review of medicine. 2024;75:113-27. https://doi.org/10.1146/annurev-med-070822-101947
Thompson W, Reeve E. Deprescribing: moving beyond barriers and facilitators. Research in social and administrative pharmacy. 2022;18(3):2547-9. https://doi.org/10.1016/j.sapharm.2021.04.004
Thompson W, Reeve E, Moriarty F, Maclure M, Turner J, Steinman MA m fl. Deprescribing: future directions for research. Research in social and administrative pharmacy. 2019;15(6):801-5. https://doi.org/10.1016/j.sapharm.2018.08.013
Veronese N, Gallo U, Boccardi V, Demurtas J, Michielon A, Taci X m fl. Efficacy of deprescribing on health outcomes: an umbrella review of systematic reviews with meta-analysis of randomized controlled trials. Ageing research reviews. 2024;95:102237. https://doi.org/10.1016/j.arr.2024.102237
Wastesson JW, Kamgang KHS, Lundby C, Pottegård A. Studying deprescribing using routinely collected healthcare data: old challenges and new opportunities. Basic and clinical pharmacology and toxicology. 2025;137(5):e70131. https://doi.org/10.1111/bcpt.70131
Wastesson JW, Minguez AC, Fastbom J, Maioli S, Johnell K. The composition of polypharmacy: a register-based study of Swedes aged 75 years and older. Plos one 2018;13(3): e0194892. https://doi.org/10.1371/journal.pone.0194892
Wastesson JW, Morin L, Tan ECK, Johnell K. An update on the clinical consequences of polypharmacy in older adults: a narrative review. Expert opinion on drug safety 2018;17:1185-96. https://doi.org/10.1080/14740338.2018.1546841
Woodward MC. Deprescribing: achieving better health outcomes for older people through reducing medications. Journal of pharmacy practice and research. 2003;33:323-8. https://doi.org/10.1002/jppr2003334323
##submission.downloads##
Publicerad
Referera så här
Nummer
Sektion
Licens
Copyright (c) 2026 Jonas W Wastesson, Carl Willers, Karl-Hermann Sielinou Kamgang, Thony Björk, Johan Fastbom, Kristina Johnell, Carina Lundby
Detta verk är licensierat under en Creative Commons Erkännande-Ickekommersiell-IngaBearbetningar 4.0 Internationell-licens.
