Tools and guidelines to assess the appropriateness of medication and aid the deprescribing: an umbrella review.

Aims: The aim of this umbrella review was to identify tools and guidelines to aid the deprescribing process of potentially inappropriate medications (PIM), evaluate development and validation methods, and describe evidence levels for medication inclusion.

Methods: Searches were conducted on MEDLINE (Ovid), Embase.com, Cochrane CDSR, CINAHL (EBSCO), Web of Science Core Collection, and guideline databases from the date of inception to July 7, 2022 and checked for updated tools on July 17, 2023. We analysed the contents of tools and guidelines.

Results: From 23 systematic reviews and guidelines, we identified 95 tools (72 explicit, 12 mixed, 11 implicit) and 9 guidelines. Most tools (83.2%) were developed to use for older persons, including 14 for those with limited life expectancy. Seven tools were for children 18 years (7.37%). Most explicit/mixed tools (78.57%) and all guidelines were validated. We found 484 PIMs and 202 medications with different appropriateness independent of disease for older persons with normal and limited life expectancy, respectively. Only two tools and eight guidelines reported the evidence level, and a quarter of medications had high-quality evidence.

Conclusion: Tools are available for a diversity of populations. There were discrepancies with the same medication being classified as inappropriate in some tools and appropriate in others, possibly due to low-quality evidence. Particularly, tools for patients with limited life expectancy were developed based on very limited evidence, and research to generate this evidence is highly needed. Our medication lists, along with the level of evidence, could facilitate efforts to strengthen the evidence.