Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines

Weir, Kristie Rebecca; Nickel, Brooke; Naganathan, Vasi; Bonner, Carissa; McCaffery, Kirsten; Carter, Stacy M; McLachlan, Andrew J.; Jansen, Jesse

doi:10.1093/geronb/gbx138

Cited by 105 publications

(167 citation statements)

References 47 publications

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“…Older adults varied in their interest for more information about their medications and involvement in decision making . For example, raising the topic of discontinuing a medication was initiated by only 18% of older adults in a Norwegian study, while 55% had done so in a US study and 42% in a Canadian study .…”

Section: Resultsmentioning

confidence: 99%

“…The Canadian study found that initiating a deprescribing conversation was more likely in older adults who searched for information about and had an awareness of medication harms . In contrast, some older adults felt fearful about expressing their medication preferences and did not share their experience of trialling deprescribing themselves until after the fact …”

Section: Resultsmentioning

confidence: 99%

“…The study by Weir et al found that this affected their confidence to initiate deprescribing discussions. The reasons for and the potential harms of their medications were not always known, or the ongoing need for some medications was not clear . Patients assumed, as their doctor had more medical knowledge than they did, that it must be appropriate to continue their medication, otherwise, their doctor would stop writing repeat prescriptions .…”

Section: Resultsmentioning

confidence: 99%

“…Concurrently, older adults expressed a strong dislike of using medications long‐term. They prefer to take as few as possible . Sometimes, nonpharmacological options were followed in order to stop medications .…”

Section: Resultsmentioning

confidence: 99%

“…However, in practice, those who reported higher trust were less likely to have experienced deprescribing . Older adults reported that their trust in the prescribing practices of their GP was based on the perceived clinical knowledge of their GP, a belief that their GP would make decisions with their best interests in mind, and on the strength of the relationship established between themselves and their GP based on mutual respect, good communication, and knowledge of their preferences . Sometimes, this level of trust meant that they did not ask for important medication information .…”

Section: Resultsmentioning

confidence: 99%

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Deprescribing medications for older adults in the primary care context: A mixed studies review

Gillespie

Harrison

Mullan

2018

Health Science Reports

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Aims: This review investigates the factors that influence deprescribing of medications in primary care from the perspective of general practitioners (GPs) and community-living older adults. Methods:A mixed studies review structure was adopted searching Scopus, CINAHL, PsychINFO, ProQuest, and PubMed from January 2000 to December 2017. A manual search of reference lists was also conducted. Studies were included if they were original research available in English and explored general deprescribing rather than deprescribing of a specific class of medications. The Mixed Methods Assessment Tool was used to assess the quality of studies, and content analysis generated common categories across studies.Results: Thirty-eight articles were included, and 7 key categories were identified.The review found that the factors that influence deprescribing are similar across and within health systems and mostly act as barriers. These factors remained unchanged across the review period. The structural organisation of health systems remains poorly suited to facilitate deprescribing. Individual knowledge gaps of both GPs and older adults influence practices and attitudes towards deprescribing, and significant communication gaps occur between GPs and specialists and between GPs and older adults. As a result, deprescribing decision making is characterised by uncertainty, and deprescribing is often considered only when medication problems have already arisen. Trust plays a complex role, acting as both a barrier and facilitator of deprescribing. towards reducing polypharmacy (including deprescribing), from the perspective of both community-living older adults and GPs. This is important because, as mentioned earlier, deprescribing is most often considered in the context of the treatment of older adults. ConclusionsThe purpose of the current review is to build on Bokhof and JuniusWalker 24 work by investigating the factors that influence deprescribing from the perspective of both GPs and adults aged 65 years or older.Independent, community-living older adults are the focus of this review, as the majority of this group retain autonomy and are capable of being responsible for their own health decisions, 17 hence the importance of considering deprescribing from their perspective. Given the increasing evidence that is now available on this topic, a review that incorporates all study types is warranted. Interventions to promote deprescribing will require change on the part of both prescribers and older adults, so it is important to consider how their views interact to create the context where deprescribing discussions can take place. | METHODSA mixed studies review methodology was used as a guide to explore the factors that influence deprescribing. 27,282.1 | Eligibility criteria | Inclusion criteriaFull text primary research articles were included that were available in English, published between January 2000 and December 2017, and that investigated deprescribing or medication cessation/discontinuation in the primary care context for ...

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 3 more Smart Citations

Deprescribing medications for older adults in the primary care context: A mixed studies review

Gillespie

Harrison

Mullan

2018

Health Science Reports

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Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

Weir,

Shang,

Choi

et al. 2023

JAMA Netw Open

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ImportanceLittle is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.ObjectiveTo examine factors important to older adults who disagree with a deprescribing recommendation given by a primary care physician to a hypothetical patient experiencing polypharmacy.Design, Setting, and ParticipantsThis online, vignette-based survey study was conducted from December 1, 2020, to March 31, 2021, with participants 65 years or older in the United Kingdom, the US, Australia, and the Netherlands. The primary outcome of the main study was disagreement with a deprescribing recommendation. A content analysis was subsequently conducted of the free-text reasons provided by participants who strongly disagreed or disagreed with deprescribing. Data were analyzed from August 22, 2022, to February 12, 2023.Main Outcomes and MeasuresAttitudes, beliefs, fears, and recommended actions of older adults in response to deprescribing recommendations.ResultsOf the 899 participants included in the analysis, the mean (SD) age was 71.5 (4.9) years; 456 participants (50.7%) were men. Attitudes, beliefs, and fears reported by participants included doubts about deprescribing (361 [40.2%]), valuing medications (139 [15.5%]), and a preference to avoid change (132 [14.7%]). Valuing medications was reported more commonly among participants who strongly disagreed compared with those who disagreed with deprescribing (48 of 205 [23.4%] vs 91 of 694 [13.1%], respectively; P &lt; .001) or had personal experience with the same medication class as the vignette compared with no experience (93 of 517 [18.0%] vs 46 of 318 [12.1%], respectively; P = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), and consideration of medication preferences (137 [15.2%]) may increase their agreement with deprescribing. Participants who disagreed compared with those who strongly disagreed were more interested in additional communication (196 [28.2%] vs 29 [14.2%], respectively; P &lt; .001), alternative strategies (117 [16.9%] vs 21 [10.2%], respectively; P = .02), or consideration of medication preferences (122 [17.6%] vs 15 [7.3%], respectively; P &lt; .001).Conclusions and RelevanceIn this survey study, older adults who disagreed with a deprescribing recommendation were more interested in additional communication, alternative strategies, or consideration of medication preferences compared with those who strongly disagreed. These findings suggest that identifying the degree of disagreement with deprescribing could be used to tailor patient-centered communication about deprescribing in older adults.

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A narrative review of evidence to guide deprescribing among older adults

Aoshima

Yabuki

et al. 2021

J of Gen and Family Med

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Potentially inappropriate prescription and polypharmacy are well‐known risk factors for morbidity and mortality among older adults. However, recent systematic reviews have failed to demonstrate the overall survival benefits of deprescribing. Thus, it is necessary to synthesize the current evidence to provide a practical direction for future research and clinical practice. This review summarizes the existing body of evidence regarding deprescribing to identify useful intervention elements. There is evidence that even simple interventions, such as direct deprescribing targeted at risky medications and explicit criteria‐based approaches, effectively reduce inappropriate prescribing. On the other hand, if the goal is to improve clinical outcomes such as hospitalization and emergency department visits, patient‐centered multimodal interventions such as a combination of medication review, multidisciplinary collaboration, and patient education are likely to be more effective. We also consider the opportunities and challenges for deprescribing within the Japanese healthcare system.

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Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines

Cited by 105 publications

References 47 publications

Deprescribing medications for older adults in the primary care context: A mixed studies review

Deprescribing medications for older adults in the primary care context: A mixed studies review

Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

A narrative review of evidence to guide deprescribing among older adults

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