Research Summary

Pharmacist-Led Deprescribing in Older Adults Shows Mixed Impact on Medication Counts

Edited by:
Anthony Calabro, MA

Key Highlights

  • Across 7 studies, pharmacist-led deprescribing did not significantly reduce total medication counts compared with usual care.
  • Two trials reported significant reductions in total medication counts with pharmacist-led interventions, while a large pragmatic trial found no significant between-group difference.
  • One cluster randomized trial reported a significant increase in deprescribing under a pharmacist-led educational model.
  • Pharmacist-led interventions improved medication burden and appropriateness indices in some studies without increasing adverse events 

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Pharmacist-led deprescribing interventions in older adults were associated with reductions in inappropriate medication use in targeted settings. Still, pooled effects on overall medication counts and hard clinical outcomes remain uncertain, according to a systematic review and meta-analysis published in BMC Geriatrics.

Investigators analyzed data from 7 studies encompassing 3,607 older adults. They found that, although individual trials demonstrated benefits in selected outcomes, pooled estimates did not show statistically significant reductions in total medications or effective deprescribing rates compared with usual care.

The review was conducted in accordance with PRISMA guidelines and registered with PROSPERO. Researchers searched PubMed/MEDLINE, ScienceDirect, the Cochrane Library, and Google Scholar for English-language randomized controlled trials and high-quality nonrandomized studies published from January 2015 through May 25, 2025. Eligible studies enrolled adults aged 65 years or older receiving regular medications and compared pharmacist-led deprescribing interventions with usual care. Although the eligibility criteria allowed the inclusion of studies conducted in any setting, the 7 included trials were conducted in community and long-term care settings.

Primary outcomes were the mean change in total number of medications per patient and the proportion of patients achieving effective deprescribing, defined as discontinuation of at least 1 potentially inappropriate medication (PIM) or a reduction of at least 0.5 in a drug burden index. Random-effects meta-analyses were performed to generate pooled estimates, and risk of bias was assessed using the Cochrane RoB 2 tool for randomized trials and the ROBINS-I tool for nonrandomized studies.

Study Findings

Among the 7 included studies (5 randomized controlled trials and 2 nonrandomized studies), interventions varied in design and intensity. Three studies were conducted in long-term care facilities and four in community settings.

The pooled mean difference in total medications at last follow-up favored pharmacist-led interventions by −0.55 medications (95% CI, −2.17 to 1.07), with substantial heterogeneity (I² = 83.1%). Similarly, the pooled risk ratio for effective deprescribing was 1.85 (95% CI, 0.63–5.45; I² = 73.5%), indicating higher odds of deprescribing in intervention groups, though not statistically significant.

Individual trials reported heterogeneous findings. Two studies demonstrated significant reductions in medication counts with pharmacist involvement, whereas a large pragmatic trial enrolling 2,470 patients found no meaningful between-group difference. In one cluster-randomized trial, the risk ratio for deprescribing with a pharmacist-led educational intervention was 3.55 (95% CI, 2.45–5.15), whereas other trials reported minimal or nonsignificant differences.

Secondary outcomes indicated improvements in medication burden indices, including the drug burden index, anticholinergic cognitive burden score, and medication appropriateness index, without an increase in adverse events. Falls, hospitalizations, and geriatric syndromes were reported with varying frequency across studies.

Clinical Implications

According to the study authors, pharmacist-led deprescribing reduces inappropriate medication use in targeted settings, but pooled effects on total medication counts and hard clinical outcomes remain uncertain. They noted that variability in study designs, intervention intensity, and outcome measures likely contributed to substantial heterogeneity.

Key limitations included high between-study heterogeneity, small sample sizes in several trials, open-label designs, and limited reporting of clinical, economic, and patient-reported outcomes. The authors also acknowledged restricting inclusion to English-language studies from selected databases.

Expert Commentary

“Our meta-analysis indicates that pharmacist-led deprescribing reduces inappropriate medication use in targeted settings, while pooled effects on total medication count and hard clinical outcomes remain uncertain,” the researchers concluded. “Variability in study designs and outcomes underscores the need for larger, thoroughly designed trials with standardized protocols, longer follow-up, and comprehensive evaluations of clinical, economic, and patient-reported outcomes to establish scalable, sustainable deprescribing practices across diverse healthcare settings.”

Reference
Tesfaye ZT, Horsa BA, Yismaw MB. Impact of pharmacist-led deprescribing interventions on medication-related outcomes among older adults: a systematic review and meta-analysis. BMC Geriatr. 2026;26(1):181. Published 2026 Jan 10. doi:10.1186/s12877-025-06964-9