Mapping the evidence on interventions to reduce potentially inappropriate prescriptions in older adults: a scoping overview of 127 systematic reviews

Potentially inappropriate prescriptions (PIPs) are highly prevalent among older adults and associated with adverse outcomes, including hospitalisations and mortality. Numerous interventions have been evaluated and synthesised in reviews, but the review-level evidence remains heterogeneous and difficult to use for decision-making. We conducted a scoping overview of systematic, scoping, and realist reviews evaluating interventions to reduce PIPs in adults aged ≥ 65 years across healthcare settings, excluding palliative care. MEDLINE, Embase, Cochrane Library, and Web of Science were searched from inception to March 2025. Reviews were mapped by intervention category, setting, drug focus, outcome domain, and methodological quality. Intervention categories were pragmatic: medication review, drug-specific focused deprescribing, educational interventions, clinical decision support systems (CDSS), comprehensive geriatric assessment (CGA), and multifaceted interventions. Methodological quality was assessed using AMSTAR-2. We included 127 reviews comprising 1,259 unique primary studies. Medication review was the dominant category (76 reviews; 59.8%) and had the broadest outcome coverage, especially for prescribing appropriateness, hospitalisations or readmissions, mortality, and quality of life. Multifaceted interventions (28; 22.0%), drug-specific focused deprescribing (27; 21.3%), educational interventions (24; 18.9%), CGA (22; 17.3%), and CDSS (17; 13.4%) were less frequently or more selectively represented. Focused deprescribing mainly addressed reducing, discontinuing, or substituting specific medicines or drug classes and showed a narrower outcome profile, with attention to prescribing appropriateness, falls, and adverse withdrawal events. Most reviews combined several settings, whereas reviews focused specifically on primary care and emergency departments were scarce. Outcomes were concentrated on prescribing indicators and selected clinical or healthcare-use endpoints, whereas safety, physical and cognitive function, adherence, acceptability and qualitative feedback, implementation processes, and formal economic evaluations were less consistently addressed. Methodological quality was predominantly low: 92 reviews (72.4%) were rated as critically low confidence and only 7 (5.5%) as high confidence. Review-level evidence on interventions to reduce PIPs in older adults is extensive but uneven, concentrated on medication review and prescribing outcomes, with more selective review-level coverage for other strategies, including focused deprescribing, CDSS, CGA, educational, and multifaceted interventions. Future syntheses should use rigorous methods and prioritise settings with limited review-level coverage, scalable technology-enabled strategies, patient-centred and safety outcomes, implementation-relevant evidence, and formal economic evaluations.