Development and validation of a deprescribing tool relevant to older persons in India using modified Delphi consensus technique

Polypharmacy is common in older persons, and some of the prescribed drugs may be potentially inappropriate medications (PIMs), whose risks outweigh their benefits. It is therefore necessary to review medication intake of older patients and deprescribe the ones that are not appropriate. Although there are many tools for deprescribing, none of these have been developed for the Indian context, where there is widespread use of fixed dose combinations (FDCs), medicines from different systems of medicines, and different levels of healthcare. Also, some of the medications listed in existing tools are not marketed in India, while some which are commonly prescribed in the country are not listed in the tools. We therefore undertook to develop a deprescribing tool for the older persons in India. A draft deprescribing tool was developed through a modified Delphi consensus process by 18 panellists. Item level content validity index (I-CVI) and scale level content validity index (S-CVI) were calculated from the Delphi round 1 and 2 responses. In addition, face and content validity of the tool was carried out by 6 experts and content validity ratio (CVR’) and I-CVI were calculated. Our draft Deprescribing tool included 63 drugs/groups organized in three sections-drugs/drug groups to avoid generally in all older patients (39 items), herb-drug interactions (5 interactions) and drugs which should be avoided in renal dysfunction (15 allopathic and 4 herbal medicines). After Delphi process and tool validation, ten drugs/drug groups were removed due to CVR’ value < 0.62 or I-CVI value < 0.67, and recommendations and/or alternatives were modified for nine drugs/groups, so that the final the tool includes 52 items – 30 drugs/drug groups to be avoided in all older persons, 7 herb-drug interactions and 15 drugs to be avoided in renal dysfunction. The scale-level content validity index (S-CVI) was 0.87 for the entire tool, which is higher than the generally acceptable 0.8. A deprescribing tool containing drugs/drug groups commonly prescribed and relevant for the older persons in India, including important herb-drug interactions, and restricted to drugs available and prescribed in India, has been developed through the Delphi process followed by tool validation.

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Journal
BMC Geriatrics
Published
2025-12-02
DOI
https://doi.org/10.1186/s12877-025-06665-3
Primary Topic
Pharmaceutical Practices and Patient Outcomes
Type
article
Field-Weighted Citation Impact
0.00

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article

Development and validation of a deprescribing tool relevant to older persons in India using modified Delphi consensus technique

Ravi Kirti, Ajay Kumar Shukla, Sandhiya Selvarajan, Danish Javed et al.
BMC Geriatrics
Pharmaceutical Practices and Patient Outcomes
article

Development and validation of a deprescribing tool relevant to older persons in India using modified Delphi consensus technique

Ravi Kirti, Ajay Kumar Shukla, Sandhiya Selvarajan, Danish Javed, Nishant Goyal, Minakshi Dhar, Rajnish Joshi, Snehil Gupta, Arvind Mathur, Shubham Atal, Bhushan Shah, Pankaj Kandwal, Mathew Varghese, Jaideep Menon, Ratinder Jhaj, Satyajit Singh, Vinod Joseph Abraham, John Ashutosh Santoshi, Ashish Goel, Ashish Kumar Kakkar, Sowparnika Treasa Sabu, Bidita Khandelwal, Arunansu Talukdar, Tarun Goyal, Rehan ul‐Haq, Jyotirmoy Pal, Anindo Majumdar, Jerin Jose Cherian, Palanimuthu Thangaraju Sivakumar, Atiya R. Faruqui, Bharat Kumar, Santanu Kumar Tripathi, A. K. Jain, Vishakha Jain, Sandeep Tiwari, Sandeep Grover, Suryaprakash Dhaneria, Kiron Varghese, Bushra Siddiqui, Padmini Devi D
article en

Abstract

Polypharmacy is common in older persons, and some of the prescribed drugs may be potentially inappropriate medications (PIMs), whose risks outweigh their benefits. It is therefore necessary to review medication intake of older patients and deprescribe the ones that are not appropriate. Although there are many tools for deprescribing, none of these have been developed for the Indian context, where there is widespread use of fixed dose combinations (FDCs), medicines from different systems of medicines, and different levels of healthcare. Also, some of the medications listed in existing tools are not marketed in India, while some which are commonly prescribed in the country are not listed in the tools. We therefore undertook to develop a deprescribing tool for the older persons in India. A draft deprescribing tool was developed through a modified Delphi consensus process by 18 panellists. Item level content validity index (I-CVI) and scale level content validity index (S-CVI) were calculated from the Delphi round 1 and 2 responses. In addition, face and content validity of the tool was carried out by 6 experts and content validity ratio (CVR’) and I-CVI were calculated. Our draft Deprescribing tool included 63 drugs/groups organized in three sections-drugs/drug groups to avoid generally in all older patients (39 items), herb-drug interactions (5 interactions) and drugs which should be avoided in renal dysfunction (15 allopathic and 4 herbal medicines). After Delphi process and tool validation, ten drugs/drug groups were removed due to CVR’ value < 0.62 or I-CVI value < 0.67, and recommendations and/or alternatives were modified for nine drugs/groups, so that the final the tool includes 52 items – 30 drugs/drug groups to be avoided in all older persons, 7 herb-drug interactions and 15 drugs to be avoided in renal dysfunction. The scale-level content validity index (S-CVI) was 0.87 for the entire tool, which is higher than the generally acceptable 0.8. A deprescribing tool containing drugs/drug groups commonly prescribed and relevant for the older persons in India, including important herb-drug interactions, and restricted to drugs available and prescribed in India, has been developed through the Delphi process followed by tool validation.

BMC GeriatricsVol. 25(1)
Indian National Science Academy (IN), Amrita Institute of Medical Sciences and Research Centre (IN), All India Institute of Medical Sciences Raipur (IN), Indian Institute of Science Education and Research Mohali (IN), Christian Medical College, Vellore (IN), Indian Council of Agricultural Research (IN), KPC Medical College and Hospital (IN), Government Vellore Medical College (IN), Karolinska Institutet (SE), Ruxmaniben Deepchand Gardi Medical College (IN), Budge Budge Institute of Technology (IN), Jharkhand Rai University (IN), R. G. Kar Medical College and Hospital (IN), Indian Council of Medical Research (IN), All India Institute of Medical Sciences Bhopal (IN), Fortis Hospital (IN), St.John's Medical College Hospital (IN), Seema Dental College and Hospital (IN), All India Institute of Medical Sciences Rishikesh (IN), Post Graduate Institute of Medical Education and Research (IN), Jawaharlal Institute of Post Graduate Medical Education and Research (IN), All India Institute of Medical Sciences (IN), National Institute of Mental Health and Neurosciences (IN), Central University of Rajasthan (IN), Sikkim Manipal University (IN), Central Institute of Psychiatry (IN)
Indian Council of Medical Research
Openalex Percentile: Top 53%
Pharmaceutical Practices and Patient Outcomes
DOIOpen Access PDFOpenAlex
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