PHARMACIST-LED DEPRESCRIBING FOR HOSPITALIZED OLDER ADULTS: CURRENT EVIDENCE, IMPLEMENTATION BARRIERS, AND FUTURE DIRECTIONS

Abstract

Background: Hospital admission creates an opportunity to reassess medicines in older adults whose frailty, multimorbidity, and acute illness may change the balance of benefit and harm. Objective: To summarise evidence on pharmacist-led deprescribing in hospitalised older adults and describe barriers to implementation. Methods: PubMed was searched through 21 June 2026. Of 115 records, 29 full-text publications were included: 18 intervention or service-evaluation reports and 11 qualitative, implementation, or tool-development reports. Owing to heterogeneity, findings were synthesised narratively. Results: Pharmacist involvement was associated with medication discontinuation, fewer potentially inappropriate medicines, reduced anticholinergic or sedative burden, and frequent acceptance of recommendations. Evidence for readmission, mortality, quality of life, and long-term sustainability remained limited. Common barriers were unclear responsibility, limited pharmacist capacity, patient concerns, fragmented records, and weak follow-up. Conclusion: Pharmacist-led deprescribing can improve medication appropriateness, but sustainable services require targeted patient selection, shared decisions, multidisciplinary accountability, monitoring, and reliable transfer of care.