PhD defence H.G. van der Meer

Inappropriate prescribing in older people is common and has been associated with increased adverse drug reactions, morbidity, hospitalisations and decreased quality of life. Deprescribing is the process of withdrawing inappropriate medications. It is a complex healthcare intervention as it involves various stakeholders, such as doctors, pharmacists, patients and patients’ caregivers. Complex healthcare interventions need to be properly developed and evaluated implemented in practice. The aim of the thesis of Heleen van der Meer was to develop and evaluate pharmacist-led interventions for deprescribing in older people, by identifying opportunities for deprescribing, evaluating a current deprescribing intervention and developing and evaluating a new deprescribing intervention. All studies in this thesis focused on specific subpopulations of older people at high risk for medication related harm, investigated different potentially inappropriate medications and used different study designs. Opportunities for deprescribing were found, such as high prescribing of preventive medications at the end of life in older nursing home residents (retrospective cohort study) and anticholinergic/sedative medications in older community-dwelling adults (cross sectional study). To reduce a high anticholinergic/sedative load in community-dwelling older adults, medication reviews as currently performed in the Netherlands, were not effective (randomized controlled trial). An innovative deprescribing intervention using information technology to target newly prescribed anticholinergic/sedative medication in this population seemed more successful (feasibility/acceptability/potential effectiveness study). Future deprescribing strategies should be patient-centred, targeted to the right population and medication, tailored to patient’s needs and have a high degree of interprofessional collaboration.