The US Deprescribing Research Network: a network to catalyze deprescribing science.

Deprescribing plays a critical role in ensuring safe and effective healthcare for older adults, including but not limited to those with vulnerabilities such as multimorbidity and dementia, which increase the risk of harm from unnecessary medications. However, much is unknown on how to safely and effectively stop medications. In response, the US Deprescribing Research Network (USDeN) was created with a mission of enhancing the quality, volume, and real-world impact of research aimed at optimizing medication use among older adults.

Alternative Treatments to Selected Medications in the 2023 American Geriatrics Society Beers Criteria®.

The American Geriatrics Society (AGS) Beers Criteria® serve to identify medications whose potential for harm outweighs their intended benefit in older adults. This highlights the need for guidance not only on what therapies to avoid but also on readily available alternative treatment strategies. AGS thus convened a multidisciplinary, interprofessional panel to develop a list of these alternative treatment strategies for older adults based on guidelines and evidence, updating an earlier effort published in 2015.

Loop diuretics and subsequent use of urinary symptom medications in older adults: evaluation of a possible prescribing cascade.

Background: Loop diuretic (LD) use may lead to a prescribing cascade whereby urinary symptoms are ascribed to genitourinary syndromes and treated with urinary symptom medications (USMs). We investigated if LDs lead to increased USM use among older adults and whether this potential prescribing cascade varies across key characteristics.

Methods: This was a prescription sequence symmetry analysis of Veterans Administration data, involving veterans ≥66 years who initiated treatment with LD (2010-2019).

Multimorbidity Profiles and Cause-Specific Mortality Among Older Adults with Schizophrenia.

Objective: To characterize multimorbidity patterns among mid- to late-life adults with schizophrenia and evaluate the relationship between multimorbidity patterns and cause-specific mortality.

Methods: This study utilized a national, longitudinal, cohort of U.S.

Household Wealth and Potentially Inappropriate Medications in Persons With Dementia: Role of Comorbidities and Caregivers.

Background: The association between lower socioeconomic status and increased potentially inappropriate medications (PIMs) among older adults, as seen in some studies, is infrequently studied in persons with dementia (PWD). This association may additionally be impacted by multimorbidity and caregiver support in PWD. Thus, we examined the association between wealth and PIMs in PWD and the effects of comorbidities and caregivers.

Management of Diabetes and Hyperglycemia in the Hospital: A Systematic Review of Clinical Practice Guidelines.

Background: Inpatient hyperglycemia is common among adults, and management varies.

Purpose: To systematically identify guidelines on inpatient hyperglycemia management.

Data Sources: MEDLINE, Guidelines International Network, and specialty society websites were searched from 1 January 2010 to 14 August 2024.

Antihypertensive Deprescribing and Functional Status in VA Long-Term Care Residents With and Without Dementia.

Background: Deprescribing antihypertensives is of growing interest in geriatric medicine, yet the impact on functional status is unknown. We emulated a target trial of deprescribing antihypertensive medications compared with continued use on functional status measured by activities of daily living (ADL) in a long-term care population.

Methods: We included 12,238 Veteran Affairs long-term care residents age 65+ who had a stay ≥ 12 weeks between 2006 and 2019.

Defining key deprescribing measures from electronic health data: A multisite data harmonization project.

Background: Stopping or reducing risky or unneeded medications ("deprescribing") could improve older adults' health. Electronic health data can support observational and intervention studies of deprescribing, but there are no standardized measures for key variables, and healthcare systems have differing data types and availability. We developed definitions for chronic medication use and discontinuation based on electronic health data and applied them in a case study of benzodiazepines and Z-drugs in five diverse US healthcare systems.

Antihypertensive Deprescribing and Cardiovascular Events Among Long-Term Care Residents.

Importance: The practice of deprescribing antihypertensive medications is common among long-term care residents, yet the effect on cardiovascular outcomes is unclear.

Objective: To compare the incidence of hospitalization for myocardial infarction (MI) or stroke among long-term care residents who are deprescribed or continue antihypertensive therapy.

Design, Setting, And Participants: This comparative effectiveness research study used target trial emulation with observational electronic health record data from long-term care residents aged 65 years or older admitted to US Department of Veterans Affairs community living centers between October 1, 2006, and September 30, 2019, and taking at least 1 antihypertensive medication.

Deprescribing of Antihypertensive Medications and Cognitive Function in Nursing Home Residents.

Importance: Antihypertensive medication deprescribing is common among nursing home residents, yet its association with cognitive decline remains uncertain.

Objective: To investigate the association of deprescribing antihypertensive medication with changes in cognitive function in nursing home residents.

Design, Setting, And Participants: This cohort study using a target trial emulation approach included VA long-term care residents aged 65 years or older with stays of at least 12 weeks from 2006 to 2019.

Cognitive Trajectories in Older Adults Diagnosed With Hematologic Malignant Neoplasms.

Importance: More people are surviving long-term after diagnosis with hematologic malignant neoplasm (HMN), yet there are limited data on cancer-related cognitive impairment in people with HMN. Better understanding cognitive outcomes after HMN in older adults is important for patient counseling and management.

Objective: To model cognitive trajectories and rates of cognitive decline before and after HMN diagnosis in older adults compared with a matched noncancer cohort.

Impact of Hospitalizations on Problematic Medication Use Among Community-Dwelling Persons With Dementia.

Background: Hospitalizations are frequently disruptive for persons with dementia (PWD) in part due to the use of potentially problematic medications for complications such as delirium, pain, and insomnia. We sought to determine the impact of hospitalizations on problematic medication prescribing in the months following hospitalization.

Methods: We included community-dwelling PWD in the Health and Retirement Study aged ≥66 with a hospitalization from 2008 to 2018.

Use of Muscle Relaxants After Surgery in Traditional Medicare Part D Enrollees.

Background: Surgeons have come under increased scrutiny for postoperative pain management, particularly for opioid prescribing. To decrease opioid use but still provide pain control, nonopioid medications such as muscle relaxants are being used, which can be harmful in older adults. However, the prevalence of muscle relaxant prescribing, trends in use over time, and risk of prolonged use are unknown.

eConsultation for Deprescribing Among Older Adults: Clinician Perspectives on Implementation Barriers and Facilitators.

Background: Electronic consultations (eConsults) enable asynchronous consultation between primary care providers (PCPs) and specialists. eConsults have been used successfully to manage a variety of conditions and have the potential to help PCPs manage polypharmacy and promote deprescribing.

Objective: To elicit clinician perspectives on barriers/facilitators of using eConsults for deprescribing among older adults within a university health network.

Survival, Function, and Cognition After Hospitalization in Long-Term Acute Care Hospitals.

Importance: More than 70 000 Medicare beneficiaries receive care in long-term acute care hospitals (LTCHs) annually for prolonged acute illness. However, little is known about long-term functional and cognitive outcomes of middle-aged and older adults after hospitalization in an LTCH.

Objective: To describe survival, functional, and cognitive status after LTCH hospitalization and to identify factors associated with an adverse outcome.

Reducing potentially inappropriate polypharmacy at a national and international level: the impact of deprescribing networks.

Introduction: Over the past decade, polypharmacy has increased dramatically. Measurable harms include falls, fractures, cognitive impairment, and death. The associated costs are massive and contribute substantially to low-value health care.

Effects of residential socioeconomic polarization on high blood pressure among nursing home residents.

Objective: Neighborhood concentration of racial, income, education, and housing deprivation is known to be associated with higher rates of hypertension. The objective of this study is to examine the association between tract-level spatial social polarization and hypertension in a cohort with relatively equal access to health care, a Veterans Affairs nursing home.

Methods: 41,973 long-term care residents aged ≥65 years were matched with tract-level Indices of Concentration at the Extremes across four socioeconomic domains.

Antihypertensive Medication and Fracture Risk in Older Veterans Health Administration Nursing Home Residents.

Importance: Limited evidence exists on the association between initiation of antihypertensive medication and risk of fractures in older long-term nursing home residents.

Objective: To assess the association between antihypertensive medication initiation and risk of fracture.

Design, Setting, And Participants: This was a retrospective cohort study using target trial emulation for data derived from 29 648 older long-term care nursing home residents in the Veterans Health Administration (VA) from January 1, 2006, to October 31, 2019.