(101) Discontinuation of chronically used medication in routine clinical practice among Swedish older adults: A nationwide cohort study

Background: Deprescribing is increasingly recognized as a feasible strategy for reducing polypharmacy and improving medication safety in geriatric care. Despite the growing interest in deprescribing, evidence on medication discontinuation rates in routine clinical practice is scarce, partly due to methodological challenges in distinguishing medically supervised discontinuation from non-adherence.

Objectives: We aim to describe the incidence of discontinuation for chronically used medications in Swedish older adults.

Methods: This was a nationwide cohort study including older adults (≥75 years) individually linked from the Total Population Register to several nationwide registers. At baseline (January 1st, 2021) we established cohorts for chronic users of specific medication classes identified as targets for deprescribing. Chronic use was defined as a medication possession ratio of ≥80% in the 24 months before the index dispensing. Index dispensing in each cohort was defined as having a dispensing with coverage that overlapped with the baseline. We estimated the one-year discontinuation rates for each medication cohort. We defined discontinuation as having no new dispensing after the end of the previous treatment episode plus a 60-day grace period.

Results: Among the 2,373,076 older adults at baseline, statins were identified as the most chronically used medication (11.9%), followed by proton-pump inhibitors (5.5%), benzodiazepines (5.1%), cholinesterase (0.6%) and bisphosphonates (0.4%). The 1-year incidence rates for medication discontinuation per 1000 person-years were 3.3 for bisphosphonates, 2.9 for proton-pump inhibitors, 2.9 for benzodiazepines, 2.8 for statins, and 2.8 for cholinesterase

Conclusions: We find low levels of discontinuation for chronically used medications recommended as target medication for deprescribing. This suggests that the growing interest in deprescribing have not yet reached routine clinical practice.