N-of-1 trials for assessing the effects of deprescribing medications on short-term clinical outcomes in older adults: a systematic review

Abstract

Objectives: The objective of this study was to determine the applicability of utilizing the N-of-1 method for deprescribing trials in older adults.

Study design and setting: Systematic review of any human studies conducted in older adults (≥50 years), deprescribing any long-term treatment over less than a year using the N-of-1 trial method was performed. Two authors independently reviewed all articles for eligibility and extracted data. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Quality assessment of trials was carried out using the Physiotherapy Evidence Database scale.

Results: Six studies were identified and extracted. Trials investigated the efficacy of pharmacological and non-pharmacological therapies for treating diseases. Four trials demonstrated non-significant benefits of treatment, with a significant number of patients discontinuing their medications in two trials where follow-up data was collected (N = 8/18, 9/14 [44.4--64.3%]). In two studies, where treatment was beneficial, all participants were found to be maintaining regimen at follow-up.

Conclusion: The N-of-1 trial methodology can be used to generate patient-specific evidence of medication and inform prescribing decisions. Future studies are required to assess the feasibility of using the N-of-1 method to determine the effects of deprescribing medications on short-term outcomes.

Keywords: Deprescribing; N-of-1; Older adults; Short-term outcomes; Systematic review.