Journal Article

Development and validation of a deprescribing tool relevant to older persons in India using modified Delphi consensus technique

Cherian, Jerin Jose, Goyal, Tarun, Kumar, Barun, Mathur, Arvind, Shah, Bhushan, Goyal, Nishant, Jain, Anil, Khandelwal, Bidita, Ul-Haq, Rehan, Selvarajan, Sandhiya, Kirti, Ravi, Siddiqui, Bushra, Menon, Jaideep, Faruqui, Atiya R., Tiwari, Sandeep, Sabu, Sowparnika Treasa, Talukdar, Arunansu, Dhaneria, S. P., Kakkar, Ashish Kumar, Majumdar, Anindo, Gupta, Snehil, Javed, Danish, Tripathi, Santanu Kumar, Devi D, Padmini, Sivakumar, Palanimuthu Thangaraju, Grover, Sandeep, Singh, Satyajit, Atal, Shubham, Kandwal, Pankaj, Joshi, Rajnish, Jhaj, Ratinder, Varghese, Mathew, Jain, Vishakha, Santoshi, John Ashutosh, Varghese, Kiron, Pal, Jyotirmoy, Goel, Ashish, Abraham, Vinod Joseph, Dhar, Minakshi, Shukla, Ajay Kumar

2025

Overview

Background Polypharmacy is common in older persons, and some of the prescribed drugs may be potentially inappropriate medications (PIMs), whose risks outweigh their benefits. It is therefore necessary to review medication intake of older patients and deprescribe the ones that are not appropriate. Although there are many tools for deprescribing, none of these have been developed for the Indian context, where there is widespread use of fixed dose combinations (FDCs), medicines from different systems of medicines, and different levels of healthcare. Also, some of the medications listed in existing tools are not marketed in India, while some which are commonly prescribed in the country are not listed in the tools. We therefore undertook to develop a deprescribing tool for the older persons in India. Methods A draft deprescribing tool was developed through a modified Delphi consensus process by 18 panellists. Item level content validity index (I-CVI) and scale level content validity index (S-CVI) were calculated from the Delphi round 1 and 2 responses. In addition, face and content validity of the tool was carried out by 6 experts and content validity ratio (CVR’) and I-CVI were calculated. Results Our draft Deprescribing tool included 63 drugs/groups organized in three sections-drugs/drug groups to avoid generally in all older patients (39 items), herb-drug interactions (5 interactions) and drugs which should be avoided in renal dysfunction (15 allopathic and 4 herbal medicines). After Delphi process and tool validation, ten drugs/drug groups were removed due to CVR’ value < 0.62 or I-CVI value < 0.67, and recommendations and/or alternatives were modified for nine drugs/groups, so that the final the tool includes 52 items – 30 drugs/drug groups to be avoided in all older persons, 7 herb-drug interactions and 15 drugs to be avoided in renal dysfunction. The scale-level content validity index (S-CVI) was 0.87 for the entire tool, which is higher than the generally acceptable 0.8. Conclusion A deprescribing tool containing drugs/drug groups commonly prescribed and relevant for the older persons in India, including important herb-drug interactions, and restricted to drugs available and prescribed in India, has been developed through the Delphi process followed by tool validation.

• Publisher: BioMed Central,BioMed Central Ltd,BMC
• Subject: Aged / Aging / Consensus / Delphi Technique / Deprescribing / Deprescriptions / Drug therapy / Drugs / Elderly / Evaluation / Geriatrics/Gerontology / Humans / Inappropriate Prescribing - prevention & control / India - epidemiology / Indian / Medicine / Medicine & Public Health / Old / Physiological aspects / Polypharmacy / Potentially Inappropriate Medication List - standards / Potentially inappropriate medications / Practice guidelines (Medicine) / Prescribing / Rehabilitation