Pharmacist-Led Deprescribing Interventions in Older Adults: A Systematic Review of Medication Appropriateness, Patient Safety, and Clinical Outcomes

Polypharmacy in older adults is associated with medication-related harm, including adverse drug events, drug-drug interactions, inappropriate prescribing, and hospitalization-related outcomes. This systematic review evaluated the effectiveness and safety of pharmacist-led deprescribing interventions in adults aged ≥65 years. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement, and searches were conducted in PubMed, Embase, and Scopus for studies published from January 2020 to December 2024. Five studies met the inclusion criteria, including two randomized controlled trials and three quasi-experimental studies across inpatient, emergency department, and ambulatory settings. Pharmacist-led interventions were generally associated with reductions in potentially inappropriate medication use and improvements in medication appropriateness. Evidence regarding adverse drug events, hospital admissions/readmissions, mortality, and other major clinical outcomes remained limited and heterogeneous. Overall, pharmacist-led deprescribing appears feasible and may improve prescribing quality, but larger randomized studies with longer follow-up are needed to determine its effect on major clinical outcomes.