Deprescribing tools in adults towards the end of life: A systematic review.

BACKGROUND: Polypharmacy is increasingly common in the community, as is the risk of associated adverse outcomes. Decreasing the use of potentially inappropriate medications may be facilitated through deprescribing tools, although their effectiveness towards the end of life remains unclear. AIM: To examine the psychometric properties of deprescribing tools and associated clinical outcomes in adults towards the end of life. DESIGN: Systematic review without meta-analysis. Eligible studies described development and application of deprescribing tools for adults towards the end of life. The ROBINS-I V2 tool assessed risk of bias. The study was registered with PROSPERO (CRD420251018366). DATA SOURCES: MEDLINE, EMBASE, CINAHL, Scopus, Web of Science, Cochrane library, and grey literature were searched from 2000 until April 2025. RESULTS: Of 4108 papers, 34 studies met inclusion criteria. Eighteen deprescribing tools were identified. The Delphi method was most frequently used for item inclusion. Definitions of end of life varied. Thirteen studies assessed reliability and/or validity; eight demonstrated reduction in the number of medicines. Clinical outcomes comparing deprescribing with control interventions were mostly non-significant, although supportive evidence existed for reduced mortality, reduced acute care referral and lower costs. Risk of bias was moderate to high. CONCLUSION: A range of deprescribing tools exist for patients towards the end of life. Deprescribing tools may reduce medication burden and improve outcomes, including mortality, acute care referral and medication costs. High risk of bias associated with these results limits strong conclusions regarding the validity and clinical impact of deprescribing tools used towards the end of life.