A new randomized clinical trial found that reducing medications for elderly hospital patients is safe but doesn’t necessarily lead to better health outcomes. The research, published in JAMA Network Open, focused on patients aged 65 and older who were taking five or more regular medications.
The study involved 442 participants with an average age of 82 years. Half received a medication optimization intervention, while the other half received their usual care. The intervention included a review of medications by a team of doctors and pharmacists, who then proposed changes to patients and their physicians.
After one year, about 49% of the elderly hospital patients in the intervention group and 52% in the usual care group had died or experienced unscheduled hospital visits or rehospitalization. This difference was not statistically significant, meaning the intervention did not improve these outcomes.
However, the intervention did successfully reduce the number of medications patients were taking. At discharge, patients in the intervention group were taking an average of one fewer medication than those in the usual care group. This difference was maintained at 6 and 12 months after discharge.
Importantly, the study found that reducing medications was safe. There was no significant increase in adverse events or falls in the intervention group compared with usual care.
The research also showed a decrease in patients taking potentially inappropriate medications. At discharge, 26% of patients in the intervention group were taking at least one potentially inappropriate medication, compared with 33% in the usual care group. This difference persisted at 6 and 12 months.
While the study didn’t demonstrate improved health outcomes, it did provide evidence that medication reduction can be safely implemented for older patients with multiple medications. The researchers suggest that future efforts might focus on more patient-centered approaches to changing health-related behaviors.
