02 | Effect of deprescribing preventive drugs on survival in frail older adults: a prospective observational study
Abstract
Introduction. Polypharmacy is a significant burden among hospitalized older adults. In frail patients with limited life expectancy, many preventive therapies become inappropriate. The time-to-benefit (TTB) for these drugs often exceeds predicted survival, making them a source of unnecessary burden rather than benefit.
Objectives. To evaluate the prevalence of preventive medication deprescribing at hospital discharge and its impact on survival, focusing on the role of frailty (Clinical Frailty Scale, CFS) and palliative needs (NECPAL surprise question).
Materials and Methods. A prospective observational study was conducted on 150 consecutive patients (mean age 84.5 ± 7.1 years; 49% women) admitted to the Acute Geriatric Ward of Baggiovara Civil Hospital (Modena, Italy) between Jan-Mar 2023. Survival was analyzed using Kaplan-Meier curves and multivariate Cox proportional hazards models, adjusting for age, sex, CFS, and Comorbidity Index.
Results. No significant differences in the frequency of preventive medication deprescribing were found based on frailty (p=0.886) or palliative status (p=0.870), indicating clinical inertia. Kaplan-Meier analysis showed that targeted preventive deprescribing did not shorten life expectancy, with median survival exceeding 15 months. In the multivariate Cox model (p<0.001), frailty (HR 3.26, p<0.001) and comorbidity (HR 1.38, p<0.001) were the strongest predictors of mortality. Notably, not performing preventive deprescribing was associated with a trend toward a higher risk of death (HR 1.527, p=0.108).
Conclusions. Targeted preventive deprescribing based on TTB is safe and does not impact survival. Reducing medication burden is crucial to enhancing the quality of life and clinical appropriateness in frail geriatric patients. Despite this, it remains underutilized regardless of prognosis. This reflects a clinical inertia that should be addressed to optimize care in the final stages of life.
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