Priority 16 from the Multiple Conditions in Later Life PSP

UNCERTAINTY: What are the most effective, cost effective and acceptable de-prescribing interventions for older people living with multiple conditions? (JLA PSP Priority 16)
Overall ranking 16
JLA question ID 0064/16
Explanatory note This largely came from health professionals who wondered how and when to deprescribe in the face of multiple conditions. However, both older people and carers also frequently commented on the large number of medications they were taking, how infrequently they had medicine reviews, concerns over whether medicines were interacting with each other and feeling bewildered about whether they actually still needed so many medicines. 
Evidence

None identified that applied directly to all conditions in the over 85s
Health Research Classification System category Generic Health Relevance
Extra information provided by this PSP
Original uncertainty examples 'Further evidence to support rationalization of medications and how medications should be stopped/started in older people with multiple health conditions.' Health professional 'How do we know whether medication is needed or effective? Told not to stop dorepezil because it 'might be working'. Can I start reducing pain killers if there is no obvious sign of pain? Why can't number of pills be rationalised/coordinated so I only have to request a prescription 4 weekly instead of every week? Why were we not told catheter supplies could be obtained direct from manufacturer who can raise prescription with surgery?' Older person 
Submitted by All forms of respondent - patients, carers, health and social care professionals
PSP information
PSP unique ID 0064
PSP name Multiple Conditions in Later Life
Total number of uncertainties identified by this PSP. 97  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 24 April 2018