Priority 16 from the Multiple Conditions in Later Life PSP

UNCERTAINTY: What are the most effective, cost effective and acceptable de-prescribing interventions for older people living with multiple conditions? (JLA PSP Priority 16)
Overall ranking	16
JLA question ID	0064/16
Explanatory note	This largely came from health professionals who wondered how and when to deprescribe in the face of multiple conditions. However, both older people and carers also frequently commented on the large number of medications they were taking, how infrequently they had medicine reviews, concerns over whether medicines were interacting with each other and feeling bewildered about whether they actually still needed so many medicines.
Evidence	None identified that applied directly to all conditions in the over 85s
Health Research Classification System category	Generic Health Relevance

Extra information provided by this PSP
Original uncertainty examples	'Further evidence to support rationalization of medications and how medications should be stopped/started in older people with multiple health conditions.' Health professional 'How do we know whether medication is needed or effective? Told not to stop dorepezil because it 'might be working'. Can I start reducing pain killers if there is no obvious sign of pain? Why can't number of pills be rationalised/coordinated so I only have to request a prescription 4 weekly instead of every week? Why were we not told catheter supplies could be obtained direct from manufacturer who can raise prescription with surgery?' Older person
Submitted by	All forms of respondent - patients, carers, health and social care professionals

Extra information provided by this PSP

Original uncertainty examples

'Further evidence to support rationalization of medications and how medications should be stopped/started in older people with multiple health conditions.' Health professional 'How do we know whether medication is needed or effective? Told not to stop dorepezil because it 'might be working'. Can I start reducing pain killers if there is no obvious sign of pain? Why can't number of pills be rationalised/coordinated so I only have to request a prescription 4 weekly instead of every week? Why were we not told catheter supplies could be obtained direct from manufacturer who can raise prescription with surgery?' Older person

Submitted by

All forms of respondent - patients, carers, health and social care professionals

PSP information
PSP unique ID	0064
PSP name	Multiple Conditions in Later Life
Total number of uncertainties identified by this PSP.	97 (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop	24 April 2018