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Díez R, Cadenas R, Susperregui J, et al. Int J Environ Res Public Health. 2022;19:4313.
Older adults living in nursing homes are at increased risk of polypharmacy and its associated adverse outcomes, such as drug-drug interactions. The medication records of 222 older adult residents of one Spanish nursing home were screened for potential drug-drug adverse events. Nearly all included residents were taking at least one potentially inappropriate medication, and drug-drug interactions were common.

Deprescribing is an intervention used to reduce the risk of adverse drug events (ADEs) that can result from polypharmacy. It is the process of supervised medication discontinuation or dose reduction to reduce potentially inappropriate medication (PIM) use.

Brühwiler LD, Niederhauser A, Fischer S, et al. BMJ Open. 2021;11:e054364.
Polypharmacy and potentially inappropriate medications continue to pose health risks in older adults. Using a Delphi approach, experts identified 85 minimal requirements for safe medication prescribing in nursing homes. The five key topics recommend structured, regular review and monitoring, interprofessional collaboration, and involving the resident.
Green AR, Aschmann H, Boyd CM, et al. JAMA Netw Open. 2021;4:e212633.
Effective communication between patient and provider is key to successful deprescribing.  Participants in this study were asked to rate potential phrases a clinician may use to explain why stopping or reducing a medication is important. The most preferred phrase involved an explanation of risk of side effects associated with the medications while the least preferred options focused on the effort involved in taking the medication and “this medication is unlikely to help you function better”. Understanding the patient’s priorities can help frame the conversation around deprescribing.
Holmqvist M, Thor J, Ros A, et al. BMC Health Serv Res. 2021;21:557.
Polypharmacy in older adults puts them at risk for adverse drug events. In interviews with primary care clinicians, researchers found that working conditions and working in partnership with colleagues, patients, and family influenced medication evaluation. They also identified two main areas of action: working with a plan and collaborative problem-solving. 
Hahn EE, Munoz-Plaza CE, Lee EA, et al. J Gen Intern Med. 2021;36:3015-3022.
Older adults taking potentially inappropriate medications (PIMs) are at increased risk of adverse events including falls. Patients and primary care providers described their knowledge and awareness of risk of falls related to PIMs, deprescribing experiences, and barriers and facilitators to deprescribing. Patients reported lack of understanding of the reason for deprescribing, and providers reported concerns over patient resistance, even among patients with falls. Clinician training strategies, patient education, and increased trust between providers and patients could increase deprescribing, thereby reducing risk of falls. 
Dellinger JK, Pitzer S, Schaffler-Schaden D, et al. BMC Geriatr. 2020;20:506.
Polypharmacy in older adults is common and may increase risk of medication-related adverse events. This study found that an intervention combining educational training, tailored health information technology, and a therapy check process improved medication appropriateness in nursing home residents.  
Orth J, Li Y, Simning A, et al. Gerontologist. 2021;61:1296-1306.
Nursing home patient safety culture is associated with healthcare quality and patient outcomes. This large cross-sectional study of nursing homes in the United States found that speaking-up behavior and communication openness were associated with a decreased risk of in-residence death among older adults with dementia. This association was strong in nursing homes located in states with higher nursing home nurse staffing requirements.  
Balsom C, Pittman N, King R, et al. Int J Clin Pharm. 2020:Epub Jun 3.
Polypharmacy is one risk factor for medication errors in older adults. This study describes the implementation of a pharmacist-administered deprescribing program in a long-term care facility in Canada. Over a one-year period, residents were randomized to receive either a deprescribing-focused medication review by a pharmacist or usual care. The intervention resulted in fewer medications taken by residents the intervention group after 6 months. Most deprescribing recommendations reflected a lack of ongoing indication or a dosage that was too high.
Rogero-Blanco E, Lopez-Rodriguez JA, Sanz-Cuesta T, et al. JMIR Med Inform. 2020;8.
Older patients are vulnerable to adverse drug events due to comorbidities and polypharmacy. This cross-sectional study from Spain reviewed prescriptions for 593 older adults aged 65-75 years with multiple comorbidities and documented polypharmacy to estimate the prevalence of potentially inappropriate prescribing using the STOPP and Beers Criteria. Potentially inappropriate prescribing was detected in over half of patients. The most frequently detected inappropriate prescriptions were for prolonged use of benzodiazepines (36% of patients) and prolonged use of proton pump inhibitors (45% of patients). Multiple risk factors associated with potentially inappropriate prescribing were identified, including polypharmacy and use of central nervous system drugs.
Huang C-H, Umegaki H, Watanabe Y, et al. PLOS ONE. 2019;14:e0211947.
Various tools for identifying potentially inappropriate medications (PIMs) have been developed. This 5-year prospective cohort study of 196 elderly patients receiving home-based medical services in Japan compared the use of two tools for identifying PIMs, the American Geriatrics Society’s Beers Criteria and the relatively new Screening Tool for Older Person’s Appropriate Prescriptions for Japanese (STOPP-J), to determine the impact of PIMs on hospitalization and mortality rates. PIMs categorized by STOPP-J were associated with hospitalization and mortality, whereas Beers Criteria PIMs were associated with hospitalization only after excluding proton pump inhibitors.
Judson TJ, Press MJ, Detsky AS. Healthc (Amst). 2019;7:4-6.
Health care is working to provide high-value care and prevent overuse while ensuring patient safety. This commentary highlights the importance of educational initiatives, mentors, and use of clinical decision support to help clinicians determine what amount of care is appropriate for a given clinical situation.
Lawton R, Robinson O, Harrison R, et al. BMJ Qual Saf. 2019;28:382-388.
Risk aversion in clinical practice may lead to the ordering of unnecessary tests and procedures, a form of overuse that may pose harm to patients. Experienced clinicians may be more comfortable with uncertainty and risk than less experienced providers. In this cross-sectional study, researchers surveyed doctors working in three emergency departments to understand their level of experience and used vignettes to characterize their reactions to uncertainty and risk. They found a significant association between more clinical experience and less risk aversion as well as a significant association between more experience and greater ease with uncertainty. The authors caution that they cannot draw conclusions on how these findings impact patient safety. An accompanying editorial suggests that feedback is an important mechanism for improving confidence in clinical decision-making. A WebM&M commentary discussed risks related to overdiagnosis and medical overuse.
Heyland DK, Ilan R, Jiang X, et al. BMJ Qual Saf. 2016;25:671-9.
Discordance between patient preferences for end-of-life care and documentation of their wishes is a common problem in hospitals. Such events have been described as silent misdiagnoses and may be classified as medical errors. This audit study across 16 hospitals in Canada quantified how often medical orders for life-sustaining treatments do not match patient preferences. Only 2% of patients who reported a preference for cardiopulmonary resuscitation (CPR) had CPR withheld in their medical orders; whereas, 35% of patients who wished to forgo CPR had orders to receive it in the event of an arrest. This mismatch represents a considerable source of potential overtreatment, which may result in numerous adverse downstream effects. A previous WebM&M commentary discussed tools for eliciting end-of-life preferences.