Deprescribing in Primary Care Patients Aged 65 Years and Older Exemplified by Hypertension, Type 2 Diabetes, and Insomnia: A Literature Review
DOI:
https://doi.org/10.12775/QS.2026.67.74289Keywords
deprescribing, elderly, polypharmacy, hypertension, type 2 diabetes, insomniaAbstract
Background. An aging population has become a fact around the world. It is estimated that by 2050, individuals over the age of 65 will constitute more than 56.7% of the European population. Aging involves a series of physiological changes and is a highly variable process among individuals. In elderly patients with hypertension, type 2 diabetes, or insomnia, treatment de-escalation is frequently required. This study identifies challenges physicians encounter in daily practice during the deprescribing process and highlights the magnitude of the problem.
Aim. The aim of this study was to review the available scientific literature regarding medication deprescribing in individuals over 65 years of age, focusing on hypertension, type 2 diabetes, and insomnia.
Material and methods. A comprehensive literature review was conducted using databases such as Medline and PubMed. The search included publications papers published between 2010 and 2026 concerning deprescribing methods and their application in elderly patients suffering from hypertension, type 2 diabetes, and insomnia.
Results. Pharmacokinetics and drug metabolism changes with age. Medications, especially those used in long term, can induce adverse effects that may be hazardous. Conversely, patients must not be deprived of essential pharmacotherapy. To address this, deprescribing algorithms have been developed to assist clinicians in clinical decision-making.
Conclusions. The analysis of available data indicates that despite the extensive number of criteria and lists focusing on medication withdrawal and their continuous updates, further research is still required regarding the clinical outcomes of their implementation in individuals over 65 years of age suffering from hypertension, type 2 diabetes, or insomnia. Furthermore, it is essential to increase the awareness and dissemination of these criteria within the medical community to facilitate their more frequent application in clinical practice.
References
1. Eurostat. Proportion of population aged 65 and over (Dataset tps00028). Luxembourg: Eurostat; 2026 [cited 2026 May 26]. Available from: https://ec.europa.eu/eurostat/databrowser/view/tps00028/default/line?lang=en
2. Eurostat. Population projections in the EU. Statistics Explained. Luxembourg: Eurostat; 2026 [cited 2026 May 26]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_projections_in_the_EU
3. Liacos M, Page AT, Etherton-Beer C. Deprescribing in older people. Aust Prescr. 2020;43(4):114-120. https://doi.org/10.18773/austprescr.2020.033
4. Bień B, Łukaszyk E. Criteria for correctness of geriatric pharmacotherapy in clinical practice based on 2019 AGS Beers, 2015 STOPP/ START and 2021 STOPPFall criteria: how to treat to do the least harm?. Białystok: Fundacja Centrum Inicjatyw na Rzecz Społeczeństwa; 2023 [cited 2026 Jun 8]. Available from: https://fundacjafcis.pl/wp-content/uploads/2022/09/KRYTERIA-POPRAWNOSCI-FARMAKOTERAPII-GERIATRYCZNEJ-W-PRAKTYCE-KLINICZNEJ-1.pdf
5. Waas T, Schulz A, Lotz J, Rossmann H, Pfeiffer N, Beutel ME, et al. Distribution of estimated glomerular filtration rate and determinants of its age dependent loss in a German population-based study. Sci Rep. 2021;11(1):10165. https://doi.org/10.1038/s41598-021-89442-7
6. Hung A, Kim YH, Pavon JM. Deprescribing in older adults with polypharmacy. BMJ. 2024 May 7;385:e074892. https://doi.org/10.1136/bmj-2023-074892
7. Trybusińska D, Musiał AJ, Chmielewska M. Health problems and diseases of old age. Gerontol Pol. 2021;29(1):39-42. Available from: https://www.akademiamedycyny.pl/wp-content/uploads/2021/07/Gerontologia_1_2021_06.pdf
8. Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: Evaluating Risks and Deprescribing. Am Fam Physician. 2019 Jul 1;100(1):32-38. Available from: https://www.aafp.org/afp/2019/0701/p32
9. Styszyński A. The role of clinical decision support systems in optimizing geriatric pharmacotherapy. Geriatria. 2023;17:209-215. https://doi.org/10.53139/G.20231729
10. Schuling J, Gebben H, Veehof LJG, Haaijer-Ruskamp FM, Blanker MH. Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012;13:56. https://doi.org/10.1186/1471-2296-13-56
11. Królik PW, Rudnicka-Drożak E. Overview of the 2019 AGS Beers Criteria Update. Geriatria. 2019;13:27-39. Available from: https://www.akademiamedycyny.pl/wp-content/uploads/2020/07/Geriatria_1_2020_03.pdf
12. Olkowski A, Dalach M, Szoszkiewicz M, Wieczorowska-Tobis K. Tools for optimizing pharmacotherapy - the FORTA (Fit fOR The Aged) list. Geriatria. 2024;18:75-82. https://doi.org/10.53139/G.20241812
13. Lunghi C, Domenicali M, Vertullo S, Tuccori M, Rossi A, Trifirò G. Adopting STOPP/START Criteria Version 3 in Clinical Practice: A Q&A Guide for Healthcare Professionals. Drug Saf. 2024;47(11):1061-1074. https://doi.org/10.1007/s40264-024-01453-1
14. Holt S, Schmiedl S, Thürmann PA. Potentially inappropriate medications in the elderly: the PRISCUS list. Dtsch Arztebl Int. 2010 Aug;107(31-32):543-551. https://doi.org/10.3238/arztebl.2010.0543
15. Mann NK, Mathes T, Sönnichsen A, Pieper D, Klager E, Moussa M, et al. Potentially Inadequate Medications in the Elderly: PRISCUS 2.0. Dtsch Arztebl Int. 2023 Jan 9;120(1-2):3-10. https://doi.org/10.3238/arztebl.m2022.0377
16. Renom-Guiteras A, Meyer G, Thürmann PA. The EU(7)-PIM list: a list of potentially inappropriate medications for older people consented by experts from seven European countries. Eur J Clin Pharmacol. 2015 Jul;71(7):861-875. https://doi.org/10.1007/s00228-015-1860-9
17. Gnjidic D, Langford AV, Jordan V, Sawan M, Sheppard JP, Thompson W, et al. Withdrawal of antihypertensive drugs in older people. Cochrane Database Syst Rev. 2025;3:CD012572. https://doi.org/10.1002/14651858.CD012572.pub3
18. McEvoy JW, McCarthy CP, Bruno RM, Brouwers S, Burato C, Castiglioni A, et al. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur Heart J. 2024 Oct 7;45(38):3912-4018. https://doi.org/10.1093/eurheartj/ehae178
19. Sheppard JP, Benetos A, Bogaerts J, Burt J, Lown M, Mant J, et al. Strategies for Identifying Patients for Deprescribing of Blood Pressure Medications in Routine Practice: An Evidence Review. Curr Hypertens Rep. 2024;26(6):225-236. https://doi.org/10.1007/s11906-024-01293-5
20. Gerard E, Quindroit P, Calafiore M, Baran J, Gautier S, Genay S, et al. Development of explicit definitions of potentially inappropriate prescriptions for antidiabetic drugs in patients with type 2 diabetes: A multidisciplinary qualitative study. PLoS One. 2024 Sep 25;19(9):e0309290. https://doi.org/10.1371/journal.pone.0309290
21. Dinarvand D, Panthakey J, Heidari A, Hassan A, Ahmed MH. The Intersection between Frailty, Diabetes, and Hypertension: The Critical Role of Community Geriatricians and Pharmacists in Deprescribing. J Pers Med. 2024 Aug 30;14(9):924. https://doi.org/10.3390/jpm14090924
22. Araszkiewicz A, Borys S, Broncel M, Budzyński A, Cyganek K, Cypryk K, et al. Clinical Recommendations on the Management of Individuals with Diabetes - 2026 Position Statement of Diabetes Poland. Curr Top Diabetes. 2026;6(1):1-172. https://doi.org/10.5114/ctd/219306
23. Marx N, Federici M, Schütt K, Müller-Wieland D, Ajjan RA, Antunes MJ, et al. 2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes. Eur Heart J. 2023 Oct 14;44(39):4043-4040. https://doi.org/10.1093/eurheartj/ehad192
24. Cabaj J, Bargieł J, Soroka E. Benzodiazepines and z-drugs - between treatment effectiveness and the risk of addiction. J Educ Health Sport. 2023;46(1):468-480. https://doi.org/10.12775/JEHS.2023.46.01.032
25. Pottie K, Thompson W, Davies S, Grenier J, Sadowski CA, Welch V, et al. Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline. Can Fam Physician. 2018 May;64(5):339-351. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC5951648/
26. Qaseem A, Kansagara D, Forciea MA, Cooke M, Denberg TD. Management of chronic insomnia disorder in adults: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2016 Jul 19;165(2):125-133. https://doi.org/10.7326/M15-2175
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Copyright (c) 2026 Zofia Biernacka, Urszula Kacprzak, Mikołaj Celmer, Mateusz Majchrzak, Julia Kossakowska, Marcin Ruszkowski, Norbert Piątkowski
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