{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T15:38:51Z","timestamp":1790264331418,"version":"4.1.0"},"reference-count":20,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["U01CE002967"],"award-info":[{"award-number":["U01CE002967"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["agsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Little is known about substitution of alternative medications in the context of deprescribing. The objectives were to: (1) determine the frequency of medication substitutions among those who discontinued a central nervous system (CNS)\u2010active medication, and (2) characterize substitutions as potentially inappropriate (as per the 2023 Beers Criteria) versus not.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a secondary analysis that combined data from the intervention and usual care arms from the STOP\u2010FALLS deprescribing trial that tested a health\u2010system\u2010embedded intervention designed to reduce prescription of CNS\u2010active medications. This analysis focused on participants followed for 360\u2009days following baseline with chronic use of opioids, benzodiazepines, tricyclic antidepressants, skeletal muscle relaxants, or Z\u2010drugs. Discontinuation was defined as the first date when there was no evidence of a prescription fill for 90\u2009days, thus only participants with a discontinuation that occurred in the first 270\u2009days were included. A list of likely alternative treatments was developed for each target medication. A substitution was operationalized as a new alternative medication prescribed during the 30\u2009days prior to or 60\u2009days after discontinuation of a target medication.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The study sample included 2182 individuals (average age 70.5\u2009years, 63.1% female). At baseline, a total of 2415 target medications were prescribed, of which 442 (18.3%) were discontinued. Discontinuation rates varied from 122 (8.0%) for users of opioids to 86 (49.7%) for users of skeletal muscle relaxants. Substitutions were made for 42 (9.5%) drug discontinuations. Of these substitutions, 11 of 42 (26.2%) were to a potentially inappropriate medication: tricyclic antidepressants (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20095), benzodiazepines (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093) and hydroxyzine (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20093). Other common substitutions included gabapentin, selective serotonin norepinephrine reuptake inhibitors, and trazodone.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Of medication discontinuations with a substitution, one\u2010quarter were to at least one potentially inappropriate medication. This finding highlights the need for additional guidance for prescribers to ensure safe deprescribing of CNS\u2010active medications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.70514","type":"journal-article","created":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T05:15:27Z","timestamp":1781241327000},"page":"2704-2709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Substitution Patterns After Discontinuation of\n                    <scp>CNS<\/scp>\n                    \u2010Active Medications in Older Adults in Primary Care"],"prefix":"10.1111","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5507-1859","authenticated-orcid":false,"given":"Shelly L.","family":"Gray","sequence":"first","affiliation":[{"name":"Department of Pharmacy, School of Pharmacy University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annalisa V.","family":"Piccorelli","sequence":"additional","affiliation":[{"name":"School of Medicine University of Washington  Seattle USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1167-6545","authenticated-orcid":false,"given":"Laura A.","family":"Hart","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, School of Pharmacy University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea J.","family":"Cook","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"},{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian D.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"},{"name":"Department of Biostatistics University of Washington  Seattle Washington USA"},{"name":"Vaccine and Infectious Disease Division Fred Hutchinson Cancer Center  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin H.","family":"Balderson","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Phelan","sequence":"additional","affiliation":[{"name":"Department of Health Systems and Population Health, School of Public Health University of Washington  Seattle Washington USA"},{"name":"Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine University of Washington  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,6,11]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2016.9225"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18372"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.949"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.4140\/TCP.n.2018.711"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12875\u2010021\u201001415\u2010x"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.16131"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.7812\/TPP\/18\u2010161"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.17121"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD015405.pub2"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.5632"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.24234"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13063\u2010023\u201007336\u20107"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.19500"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2022.3680"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40266\u2010023\u201001066\u2010w"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.9043"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2022.910719"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.18005"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.180551"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15519"}],"container-title":["Journal 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