A systematic review on methods for developing and validating deprescribing tools for older adults with limited life expectancy

Objectives A number of deprescribing tools are available to assist clinicians to make decisions on medication management. We aimed to review deprescribing tools that may be used with older adults that have limited life expectancy (LLE), including those at the palliative and end-of-life stage, and consider the rigour with which the tools were developed and validated. Key findings Literature was searched in PubMed, Embase, CINHAL and Google Scholar until February 2021 for studies involving the development and/or consensus validation of deprescribing tools targeting those aged >= 65 years with LLE. We were interested in the tool development process, tool validation process and clinical components addressed by the tool. Six studies were included. The approaches followed for tool development were systematic review (n = 3), expert-literature review (n = 2) and concept data (n = 1). The content included a list of disease-non-specific medications divided with or without recommendations (n = 4) and disease-specific medications with recommendations (n = 2). The tool validation was performed using the Delphi method (n = 4) or GRADE framework (n = 2) with panel size ranging from 8 to 17 and 60-80% consensus agreement with or without a rating scale. LLE targeted were <= 1 year (n = 2) or <= 3 months (n = 1). There is a limited number of deprescribing tools with consensus validation available for use in older adults with LLE. These tools are either targeted for disease-specific medication/medication class guided by the GRADE framework or targeted for a list of medications or medication classes irrespective of disease that are developed using a combination of approaches and validated using a Delphi method.

Automated summary

This study reviewed deprescribing tools for older adults with limited life expectancy and assessed the rigor of their development and validation. The findings indicate that there is a limited number of consensus-validated deprescribing tools available for use in this population. These tools target specific disease medications or medication classes guided by the GRADE framework, or a list of medications irrespective of disease, developed using various approaches and validated using the Delphi method.