Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy

Galazzi, Alessandro; Lusignani, Maura; Chiarelli, Maria Teresa; Mannucci, Pier Mannuccio; Franchi, Carlotta; Tettamanti, Mauro; Reeve, Emily; Nobili, Alessandro

doi:10.1007/s11096-016-0279-4

Cited by 72 publications

(84 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This study found that most older adults (88%) and caregivers (84%) were willing to have a medication deprescribed if their or their care recipient's doctor said it was possible. These results confirm those of previous smaller studies of the PATD internationally that found between 70% and 90% of older adults were willing to stop a medication . This is the first quantitative investigation into caregiver attitudes toward deprescribing.…”

Section: Discussionsupporting

confidence: 89%

“…In 2012, the Patients’ Attitudes Towards Deprescribing (PATD) questionnaire was developed and validated to explore quantitatively how individuals felt about their medications and the potential for one or more of their medications to be withdrawn . Contrary to prescriber reports, six studies internationally revealed between 70% and 90% of older adults were willing stop one or more medications, if their doctor said it was possible …”

mentioning

confidence: 99%

See 1 more Smart Citation

Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

Reeve

Low

Hilmer

2019

J American Geriatrics Society

Self Cite

101

View full text Add to dashboard Cite

BACKGROUND/OBJECTIVES Use of harmful and/or unnecessary medications in older adults is common. Understanding older adult and caregiver attitudes toward deprescribing will contribute to medication optimization in practice. The aims of this study were to capture the attitudes and beliefs of older adults and caregivers toward deprescribing and determine what participant characteristics and/or attitudes (if any) predicted reported willingness to have a medication deprescribed. DESIGN Self‐completed questionnaire. SETTING Australia. PARTICIPANTS Older adults (n = 386), 65 years or older, taking one or more regular prescription medications and caregivers of older adults (n = 205) who could self‐complete a written questionnaire in English. MEASUREMENTS Older adult and caregiver versions of the validated revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire were completed. The rPATD includes two global questions and four factors: perceived burden of medications, belief in appropriateness of medications, concerns about stopping, and involvement in medication management. Participant characteristics, self‐rated health, trust in physician, and health autonomy were also collected. RESULTS Older adult participants had a median age of 74 years (interquartile range [IQR] = 70‐81 y), and caregivers were aged 67 years (IQR = 59‐76) and were caring for a person aged 81 years (IQR = 75‐86.25 y). Most of both older adults (88%) and caregivers (84%) agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible. In a binary logistic regression model, a low concern about stopping factor score was the strongest predictor of willingness to have a medication deprescribed in older adults (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.04‐0.34). Excellent/good rating of physical health was the strongest predictor in caregivers (OR = 3.71; 95% CI = 1.13‐12.23). CONCLUSIONS Most older adults and caregivers are willing to have one of their or their care recipient's medication deprescribed, although different predictors (characteristics/attitudes) of this willingness were identified in these two groups.

show abstract

Section: Discussionsupporting

confidence: 89%

mentioning

confidence: 99%

Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

Reeve

Low

Hilmer

2019

J American Geriatrics Society

Self Cite

101

View full text Add to dashboard Cite

show abstract

“…The Patients’ Attitudes Towards Deprescribing (PATD) instrument was developed in 2013 . Studies based on this questionnaire from Italy and Australia suggest that most hospitalized older patients, outpatients, and nursing home residents think they take a large number of medications and would like to reduce the number of drugs they take on a daily basis. However, patients in these studies generally were not treated with excessive polypharmacy …”

Section: Introductionmentioning

confidence: 99%

Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark

Schiøtz

Frølich

Jensen

et al. 2018

Pharmacology Res & Perspec

View full text Add to dashboard Cite

Polypharmacy is common among multimorbid adults and associated with increased morbidity and mortality. Excessive polypharmacy (ie, ≥10 medicine) is strongly associated with inappropriate medication use, but little is known about attitudes toward deprescribing in patients with excessive polypharmacy. We surveyed 100 Danish individuals aged 65 years and above with ≥10 prescribed medications, using the validated Patients’ Attitudes Towards Deprescribing (PATD) instrument. Most participants (81, 81%) thought they took a large number of medications, and 79 (79%) believed that their medications were necessary. Even so, 85 (85%) reported that they would be willing to stop taking one or more of their regular medications if their doctor told them they could, and 11 (11%) felt that they took at least one regular medication that they no longer needed. When presented with visual presentation of various amounts of tablets and capsules, 62 (62%) of participants reported that they would be comfortable taking fewer medications than they did. Forty‐two (42%) participants had experience with stopping a regular medication. Almost all participants (92%) wanted to receive follow‐up by various means if a medication was discontinued. Forty‐one (41%) participants were interested in a consultation at an outpatient clinic specializing in polypharmacy. Overall, the answers to the PATD questionnaire suggest that our cohort of Danish, multimorbid outpatients with extensive polypharmacy have a high confidence in their healthcare providers for medication‐related decisions, even though some feel that they are taking more medications than they would like to and feel that some medications may be unnecessary. Our results underline the need for healthcare providers to offer medication reviews in patients with multimorbidity.

show abstract

“…Two‐thirds of Canadian community‐dwelling older adults are aware that some prescriptions can cause harm, half of them research information about medication harms, and only 6.9% are familiar with the term “deprescribing.” Awareness of medication harms, actively searching for information on medication harms, and knowledge of the term “deprescribing” are positively associated with initiating a deprescribing conversation; 41.8% of older adults surveyed in this study reported discussing deprescribing with a healthcare provider, although this prevalence is lower than the 50.8% of community‐dwelling older adults and 89% of hospitalized older adults who would like to reduce the number of medications they take . Approximately three‐quarters of community‐dwelling older adults are willing to cease one of their medications if their doctor says it is possible, with 51.2% and 42.6% in favor of their pharmacist or nurse leading the deprescribing process, respectively.…”

Section: Discussionmentioning

confidence: 80%

Older Adults’ Awareness of Deprescribing: A Population‐Based Survey

Turner

Tannenbaum

2017

J American Geriatrics Society

View full text Add to dashboard Cite

ObjectivesTo determine older adults’ awareness of the concept of medication‐induced harm and their familiarity with the term “deprescribing.” Secondary objectives were to ascertain determinants of self‐initiated deprescribing conversations and to identify how older adults seek information on medication harms.DesignCross‐sectional population‐based household telephone survey using random‐digit dialling.SettingCanada.ParticipantsCommunity‐dwelling adults aged 65 and older (N = 2,665; n = 898 men, n = 1,767 women, mean age 74.9 ± 7.2, range 65–100).MeasurementsInformation was gathered on age; sex; awareness of the term “deprescribing”; knowledge and information‐seeking behaviors related to medication harms; and previous initiation of a deprescribing conversation with a healthcare professional. Three targeted classes of potentially inappropriate prescriptions were asked about: sedative‐hypnotics, glyburide, and proton pump inhibitors. Descriptive statistics and regression analyses were used to quantify associations.ResultsTwo‐thirds (65.2%, 95% confidence interval (CI) = 63.4–67.0%) of participants were familiar with the concept of medication‐induced harms. Only 6.9% (95% CI = 5.9–7.8%) recognized the term deprescribing; 48% (95% CI = 46–50%) had researched medication‐related harms. Older adults most commonly sought information from the Internet (35.5%, 95% CI = 33.4–37.6%), and from health care professionals (32.2%, 95% CI = 30.1–34.3%). Patient‐initiated deprescribing conversations were associated with awareness of medication harms (odds ratio (OR) = 1.74, 95% CI = 1.46–2.07), familiarity with the term deprescribing (OR = 1.55, 95% CI = 1.13–2.12), and information‐seeking behaviors (OR = 4.57, 95% CI = 3.84–5.45), independent of age and sex.ConclusionHealthcare providers can facilitate patient‐initiated deprescribing conversations by providing information on medication harms and using the term “deprescribing.”

show abstract

Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy

Cited by 72 publications

References 28 publications

Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark

Older Adults’ Awareness of Deprescribing: A Population‐Based Survey

Contact Info

Product

Resources

About