gms | German Medical Science

Background and aims: Older adults often present multimorbidity, polypharmacy, inappropriate prescriptions and adverse drug reactions. There is a need to carefully weigh the risks and benefits of medication in this population. Aims: 1) to identify the evidence on the risks and benefits of drugs commonly used in older adults; 2) to provide recommendations on their use, which can be incorporated into an electronic decision support tool aimed at supporting General Practitioners (GPs) to reduce inappropriate prescriptions.

Methods: Most common drugs used in older adults were identified using prescription data from several European countries. A Systematic Review (SR) was planned for each drug; study protocols and a standard operating procedure were developed and approved by a team of 12 researchers. The PICOS-framework was used for the development of the search terms. Literature search comprised three searches, each of which being undertaken only if the previous one did not yield recent and high quality results: searches 1 and 2 identified SRs and meta-analyses in the Cochrane Database of Systematic Reviews and DARE, and in MEDLINE, EMBASE, HTA and IPA databases, respectively, covering the time since their inception. Search 3 identified controlled intervention and observational studies from the SR not included in searches 1 and 2 but containing eligible studies, and from the databases considered in search 2, covering the last 10 years. Inclusion criteria: participants aged ≥65 (SRs: mean age ≥65 or >80% studies with mean age ≥65; original studies: >80% participants aged ≥65) or subgroup analysis of this population; clinically relevant endpoints.

For each SR, two trained reviewers are currently independently selecting studies for inclusion, doing data extraction and quality appraisal. Based on the evidence found, an expert team will develop recommendations using GRADE methodology, which will be integrated into an electronic decision tool. The tool will automatically make each recommendation visible to GPs when specific patient conditions are identified.

Results: Thirteen SR are on-going: search 1 is being performed in n=4 drugs; search 2 in n=8 drugs; search 3 in n=1 drug. Four evidence-based recommendations on one drug have already been incorporated into the tool.

Discussion: This electronic decision support tool will be tested in a randomised controlled trial, starting in March 2014. This study is part of the 7th Framework European Project PRIMA-eDS (Grant agreement 305388), a collaboration of 6 European countries.