Volume 8, Issue 4

Polypharmacy is common among older adults with multimorbidity and is associated with adverse drug events, falls, hospital admissions, and a substantial burden of treatment. Deprescribing, the supervised process of reducing or stopping medicines whose harms outweigh their benefits, is increasingly recommended but remains inconsistently practiced in primary care. This review summarizes the evidence on structured deprescribing for older adults with multimorbidity and examines the tools and implementation strategies available to general practitioners and pharmacists. Randomized trials show that structured medication reviews reliably reduce the number of potentially inappropriate medicines and can be carried out safely, whereas effects on hospital admission, mortality, and quality of life have been inconsistent, largely because trials were underpowered for these outcomes and many recommendations were never implemented. Explicit criteria such as STOPP/START and the Beers Criteria, implicit approaches such as the Medication Appropriateness Index, drug-specific algorithms, and patient-facing materials each support different stages of the process. Barriers include fragmented prescribing across specialties, limited consultation time, clinician uncertainty about stopping guideline-recommended drugs, and patient concern about withdrawal. Interventions appear most effective when they combine a systematic review of the full medication list with shared decision-making, pharmacist involvement, and planned follow-up of tapering. We propose a practical stepwise approach for primary care and outline research priorities, including trials with patient-relevant outcomes and evaluation of digital decision support.

Background. Night-shift work reduces daytime sun exposure and may predispose healthcare workers to vitamin D deficiency, but comparative data from Turkish hospitals are limited. This study compared vitamin D status between night-shift and day-shift hospital staff. Methods. We conducted a cross-sectional study of 312 healthcare workers at a university hospital in Izmir between February and April 2025, comprising 156 workers with regular night shifts and 156 day-shift workers. Serum 25-hydroxyvitamin D (25(OH)D) was measured by chemiluminescent immunoassay, and deficiency was defined as a concentration below 20 ng/mL. Associated factors were examined with multivariable logistic regression. Results. The median 25(OH)D concentration was 15.8 ng/mL (interquartile range 11.2–21.4), and 216 participants (69.2%) were deficient. Deficiency was more common among night-shift than day-shift workers (79.5% vs 59.0%, p < 0.001), as was severe deficiency below 10 ng/mL (24.4% vs 10.9%, p = 0.002). Night-shift work remained independently associated with deficiency after adjustment for age, sex, body mass index, supplement use, and daily daylight exposure (adjusted odds ratio 2.61, 95% CI 1.49–4.57). Conclusions. Vitamin D deficiency was highly prevalent among hospital staff, particularly those working night shifts. Occupational health services should consider targeted screening or routine supplementation for night-shift workers.