The ‘Geriatrician’s Salute’: emerging evidence on deprescribing

Professor Sarah Hilmer works as a geriatrician and clinical pharmacologist at Royal North Shore Hospital in Sydney, and conjoint professor of geriatric pharmacology at Sydney University, Australia.  Dr Danijela Gnjidic is a pharmacologist who is a NHMRC Dementia Leadership Fellow and Senior Lecturer in Pharmacy Practice at Sydney University, Australia. 

One of the most reversible causes of a geriatric syndrome in our older patients is an adverse drug event.  Approximately 1 in 5 hospital admissions amongst older people are due to adverse drug reactions and during their time in hospital 1 in 6 older people experience an adverse drug reaction.  Consequently, comprehensive medication review is an integral part of the practice of geriatric medicine.

The process of a health professional withdrawing medicines for which the current risk may outweigh the benefit in their patient has been given a variety of names including the ‘geriatrician’s salute’ and increasingly ‘deprescribing’. 

The rise of deprescribing as a word with a definition, evidence base and implementation plan, reflects the changing environment in which we practice.  In particular, the emphasis on evidence based medicine and the need to care for our rapidly ageing populations, which requires application of components of geriatric evaluation and management by a wider range of health care practitioners.

However, there are still significant challenges related to research on the safety, efficacy and implementation of deprescribing.  In our commentary in Age and Ageing, we discuss the current evidence on the effects of deprescribing, emergence of implementation tools to embed deprescribing into the clinical care of older adults, as well as efforts to develop guidelines to improve healthcare practitioners’ awareness and self-efficacy of deprescribing.

Policy initiatives such as Choosing Wisely, which aims to identify and reduce low value care, and the WHO Third Global Patient Safety Challenge: Medication Without Harm, can support and guide widespread implementation of deprescribing.

Internationally, the majority of consumers report that they would like to stop a medicine if their doctor said that they could.  This provides impetus to generate the evidence and systems needed to deprescribe safely in practice. It should also give us confidence as clinicians to discuss deprescribing with our patients.