Abstract / Summary
Background: Polypharmacy is highly prevalent among older adults with multimorbidity and is associated with potentially inappropriate medications (PIMs), adverse drug events, falls, and functional decline.This review aimed to clarify what outcomes deprescribing has evidence for, with a focus on pharmacist-led interventions and a Korea-specific implementation pathway.Methods: We conducted a narrative review using targeted searches of major biomedical databases and relevant guidelines published since 2010, supplemented by reference list screening.We summarized commonly used deprescribing tools (e.g., Beers, STOPP/START, STOP-PFrail; Medication Appropriateness Index; Drug Burden Index) and interpreted outcomes by distinguishing intermediate prescribing outcomes from hard clinical outcomes, while considering setting and follow-up intensity.Results: Deprescribing interventions generally reduce PIM exposure and medication burden across community, hospital, and long-term care settings.Evidence is more consistent for intermediate outcomes than for hospitalization or mortality, which remain heterogeneous across studies.Pharmacist-led structured medication reviews improve prescribing appropriateness and burden indices; effects on falls and medication-related harms are mixed and appear more likely when targeting high-risk drugs and providing structured follow-up.Intervention impact is context-dependent, influenced by interprofessional uptake and workflow integration.Conclusions: Deprescribing is feasible and generally safe for older adults with multimorbidity.Clinical pharmacists are central to identifying targets, supporting shared decision-making, and coordinating monitoring.Scaling deprescribing in Korea will likely require standardized documentation, access to complete medication lists, and reimbursement mechanisms supporting medication review and follow-up across care transitions.