Deprescribing in senior care is gaining momentum, especially as studies show that inappropriate medication use is a significant issue. Long-term care (LTC) pharmacy services, including efforts such as the consultant pharmacist’s medication regimen reviews (MRR), are key to addressing common overprescribing and polypharmacy issues, as well as preventing the use of potentially inappropriate medications (PIMs) in seniors.

This isn’t just an issue in the United States. According to one study of people over age 60 from 17 countries,  the prevalence of potentially inappropriate medication use is 36.7% worldwide. The authors also noted that this issue has increased by more than 40% internationally over the past decade. As the older population continues to grow, this problem isn’t likely to go away on its own. For instance, a recent study showed that older adults’ exposure to gabapentinoids, proton pump inhibitors, and antipsychotics, three categories of PIMs, increased between 2013 and 2021, even though overall spending on PIMs went down.

The National Institute on Aging (NIA) has had deprescribing on its radar for some time, and in 2021 funded the U.S. Deprescribing Research Network, which brought together researchers — including physicians and pharmacists — interested in addressing deprescribing and contributing to the body of literature on the issue. The group aims to create and share resources and support promising pilot studies. As one researcher said, “Despite its role as an integral part of patient-centric and goal-concordant prescribing practice, deprescribing is not frequently incorporated into routine clinical practice. We need to develop processes to overcome patient- and physician-based barriers that can lead to increased patient confidence in continuing or discontinuing medications.”

There is ongoing work and study on deprescribing, but it is clear that the consultant pharmacist plays a key role in these efforts. A recent literature review analyzed 20 studies and determined that pharmacists involved in deprescribing — via efforts such as medication reviews, collaborations with other care team members, and education/training — had an impact on benzodiazepine deprescribing which, in turn, contributed to better health and economic outcomes.

At a time when providers face unprecedented challenges, the consultant pharmacist has a key role in helping them address issues such as deprescribing. The consultant pharmacist can help providers reduce hospitalizations and adverse events by optimizing management of residents’ medications through deprescribing and identifying patients at risk for problems such as falls. Follow-through, including maintaining written policies for managing consultant pharmacists recommendations and involvement with these professionals, are key to quality improvement efforts.