Prospective cohort study of nonspecific deprescribing in older medical inpatients being discharged to a nursing home.

"Conflict of interest statement: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article."

"Funding: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was supported by a grant from the Registry of Senior Australians based at the South Australian Health and Medical Research Institute."

"Our study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN12616001336471. This was a prospective cohort study of older medical inpatients (>75 years) on five or more regular medications, a commonly accepted definition of polypharmacy, before an unplanned admission to five metropolitan hospitals in Adelaide, South Australia, between June 2018 and April 2019. The study is reported according to the STROBE checklist for observational studies. All patients were discharged to permanent placement in a nursing home. Ethics approval was obtained for the study from the Royal Adelaide Hospital Ethics Committee (HREC/15/RAH/302) with mutual recognition at participating sites. We investigated the associations between deprescribing and mortality, readmission rate, and HRQOL. Patients consented to ongoing follow-up; deprescribing that occurred while in hospital was not on a voluntary basis, but in line with best practice that medications be reviewed and nonbeneficial medications ceased. Patients were categorised and analysed according to whether they had medication deprescribed or not. Since medication reconciliation can sometimes be delayed, patients were excluded if admitted for less than 48 hours; we also excluded patients expected to die within 30 days. Conclusion:: Deprescribing certain classes of medications during hospitalisation was associated with worse mortality, but not readmissions or overall HRQOL. Larger controlled deprescribing studies targeting specific medications are warranted to further investigate these findings.: This study was registered with the Australian and New Zealand Clinical Trials Registry, ACTRN1 2616001336471."