Deprescribing in a geriatric virtual ward

Deprescribing 'the planned and supervised reduction or cessation of medications that may no longer be beneficial or may cause harm - is increasingly recognised as central to quality use of medicines in older adults, however, translating deprescribing into routine clinical practice remains challenging (1).

Barriers include clinician concerns about withdrawal effects or symptom recurrence, patient reluctance to discontinue long-standing therapies, and system-level issues such as time constraints, fragmented care, and unclear responsibility across transitions of care (1-2).

Medication-related harm in older adults is driven not only by medication count but also by cumulative exposure to medicines with anticholinergic or sedative properties. The Drug Burden Index is a validated measure of this exposure and is associated with impaired physical and cognitive function, increased falls, hospitalisation, and mortality (3).

Reducing Drug Burden Index is therefore an important and clinically meaningful target for deprescribing interventions, particularly among older adults with complex medication regimens.

Integrated, multidisciplinary models of care may help address common barriers to deprescribing. Geriatric Evaluation and Management in the Home is an emerging model within Australian health services that delivers sub-acute, hospital-level care in the patient's home as a hospital substitution or avoidance pathway. Care is led by a geriatrician and delivered by a multidisciplinary team, with medication review and deprescribing embedded as routine components of care. The Geriatric Evaluation and Management in the Home model provides a time-limited, controlled environment that enables close monitoring of medication changes, iterative dose adjustment, and coordinated communication with general practitioners and specialists, facilitating implementation of deprescribing recommendations in the home setting and reducing the risk of unintended medication re-initiation after discharge.

Despite these theoretical advantages, deprescribing within Geriatric Evaluation and Management in the Home models have not been systematically evaluated. Existing literature focuses largely on inpatient, residential aged care, or primary care settings, with limited evidence from home-based hospital-substitution models (4-5).

This study addressed this gap by exploring deprescribing practices within an Australian Geriatric Evaluation and Management in the Home service. The findings will inform future service development, strengthen medication optimisation initiatives, and support continuity of care after discharge.

Geriatric Evaluation and Management in the Home-led deprescribing was frequently implemented and largely maintained, supporting the feasibility of deprescribing within a structured, virtual ward model of care. By exploring local deprescribing practices, we gained valuable insight into Geriatric Evaluation and Management in the Home service delivery and, importantly, into consumer experience. High levels of patient and carer satisfaction provided reassurance that deprescribing approaches were acceptable, supportive, and aligned with consumer priorities.

A key learning from this work was highlighting the importance of planning beyond the point at which deprescribing recommendations are made. The findings have been applied locally to ensure Geriatric Evaluation and Management in the Home clinicians consider what occurs after discharge, including access to general practitioners, clarity of primary care handover, and the need for timely geriatrician follow-up for more complex or high-risk medication changes. Clear, consumer-friendly communication emerged as central to maintained deprescribing, supporting patient understanding and confidence during transitions of care.