Author: Degefaye Anlay
Date: 02-09-2026
Supervisors:
Prof. Dr. Joachim Cohen, End-of-Life Care Research Group, VUB
Prof. Dr. Tinne Dilles, Centre for Research and Innovation in Care, UAntwerp
Dr. Kristel Paque, Centre for Research and Innovation in Care, UAntwerp
Abstract
Nursing home residents often take many medicines, some of which may no longer be helpful at the end of life and can even cause harm. Although deprescribing, the stopping or reducing of unnecessary medicines, is increasingly recommended in guidelines, it remains unclear how well this is reflected in practice and evidence on the effects of stopping these medicines remains limited, especially on outcomes that matter most, such as quality-of-life-related outcomes. To strengthen the evidence base, I first reviewed existing deprescribing tools and guidelines, finding that the overall level of evidence is low and recommendations are often inconsistent.
Then, using linked healthcare reimbursement data, I analysed deprescribing trends over time, the impact of guidelines on actual practice, and rate of reinitiation of discontinued medicines, and conducted interviews with healthcare professionals to explore barriers and enablers.
The results show that deprescribing occurs in only about 1 in 3 residents, has small declined over time, and that 1 in 5 discontinued medicines are restarted, while international guidelines did not change practice, indicating that deprescribing is not yet well embedded in routine care. Additionally, I investigated the effects of deprescribing proton pump inhibitors and found that it did not worsen quality-of-life outcomes while reducing hospital admissions, highlighting its potential to reduce low-value care, although it did not improve patient experience.
Finally, I conducted a case study on challenges in accessing and using data, finding that access is often slow and complex, which limits timely evidence generation. Future efforts should focus on stronger implementation strategies, broader evidence across medications, and more efficient access to healthcare data.
