Medication deprescribing and its effects in polymedicated geriatric patients: a systematic review

Introduction: Polypharmacy, defined as the concurrent use of five or more medications, is highly prevalent among older adults and is associated with increased risks of adverse drug reactions, drug–drug interactions, and functional decline. Deprescribing, defined as the planned and supervised withdrawal of potentially inappropriate medications, is an important strategy to optimize therapy, reduce risks, and improve quality of life. Despite its potential, deprescribing implementation still faces clinical, structural, and cultural barriers, highlighting the need for robust evidence and standardized protocols. Objectives: To conduct a systematic review to identify, analyze, and synthesize the evidence on the impact of deprescribing in older adults with polypharmacy, considering clinical outcomes, medication burden reduction, and implementation barriers. Methods: A comprehensive search was performed in PubMed, Web of Science, and Google Scholar, including publications from 2015 to 2024. Eligible studies were systematic reviews, with or without meta-analysis, involving older adults (≥60 years) taking ≥5 medications and subjected to deprescribing interventions. Outcomes of interest included quality of life, reduction in the number of medications, and adverse events. Screening and selection followed PRISMA 2020 guidelines, with blinded and independent review by pairs of evaluators, and disagreements resolved by a third reviewer. Results: A total of 3,843 records were identified, of which 1,113 were excluded as duplicates. After applying inclusion and exclusion criteria, 1,020 articles underwent title and abstract screening, resulting in 92 included studies, of which 90 proceeded to full-text review. The selected studies indicate that deprescribing can reduce the use of potentially inappropriate medications, lower the occurrence of adverse events, and maintain or improve quality of life without significantly increasing mortality. Discussion: The analysis shows that, while deprescribing consistently offers benefits, its adoption is hindered by clinical inertia, lack of clear guidelines, patient and clinician beliefs, and care fragmentation. The use of algorithms, explicit criteria (such as Beers and STOPP/START), and computerized tools, combined with multidisciplinary team involvement, is essential for effective implementation. Furthermore, there is a scarcity of studies integrating pharmacokinetic data into deprescribing decision-making, highlighting an opportunity for more personalized approaches. Partial Conclusion: Deprescribing in older adults with polypharmacy is a safe and potentially effective intervention to reduce risks and improve clinical outcomes. Standardizing protocols, training healthcare professionals, and incorporating decision-support tools, including pharmacokinetic modeling, may enhance its applicability and impact. Future studies should explore integrated strategies that consider individual variability and clinical context to optimize deprescribing benefits.