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

Turner, Justin P.; Tannenbaum, Cara

doi:10.1111/jgs.15079

Cited by 40 publications

(46 citation statements)

References 25 publications

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“…We also showed that patients and caregivers were able to weigh these factors, especially evident when presented with clinical scenarios, indicating they would be able to participate in shared decision making and engage in conversations surrounding deprescribing. This is further supported by studies that show patients who were more aware of medication harm and the term “deprescribing” were more likely to initiate conversations related to deprescribing . By understanding factors that impact patients' and caregivers' perceived value of a medication, prescribers and health systems can more ably identify and prioritize medications in conjunction with patients that they would find mutually acceptable to discontinue.…”

Section: Discussionmentioning

confidence: 84%

Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

Pickering

Hamm

Dawdani

et al. 2020

J American Geriatrics Society

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OBJECTIVES Shared decision making is essential to deprescribing unnecessary or harmful medications in older adults, yet patients' and caregivers' perspectives on medication value and how this affects their willingness to discontinue a medication are poorly understood. We sought to identify the most significant factors that impact the perceived value of a medication from the perspective of patients and caregivers. DESIGN Qualitative study using focus groups conducted in September and October 2018. SETTING Participants from the Pepper Geriatric Research Registry (patients) and the Pitt+Me Registry (caregivers) maintained by the University of Pittsburgh. PARTICIPANTS Six focus groups of community‐dwelling adults aged 65 years or older, or their caregivers, prescribed five or more medications in the preceding 12 months. MEASUREMENTS We sought to identify (1) general views on medication value and what makes medication worth taking; (2) how specific features such as cost or side effects impact perceived value; and (3) reactions to clinical scenarios related to deprescribing. RESULTS We identified four themes. Perceived effectiveness was the primary factor that caused participants to consider a medication to be of high value. Participants considered a medication to be of low value if it adversely affected quality of life. Participants also cited cost when determining value, especially if it resulted in material sacrifices. Participants valued medications prescribed by providers with whom they had good relationships rather than valuing level of training. When presented with clinical scenarios, participants ably weighed these factors when determining the value of a medication and indicated whether they would adhere to a deprescribing recommendation. CONCLUSION We identified that perceived effectiveness, adverse effects on quality of life, cost, and a strong relationship with the prescriber influenced patients' and caregivers' views on medication value. These findings will enable prescribers to engage older patients in shared decision making when deprescribing unnecessary medications and will allow health systems to incorporate patient‐centered assessment of value into systems‐based deprescribing interventions. J Am Geriatr Soc 68:746–753, 2020

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Section: Discussionmentioning

confidence: 84%

Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

Pickering

Hamm

Dawdani

et al. 2020

J American Geriatrics Society

View full text Add to dashboard Cite

show abstract

“…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 . 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 .…”

Section: Resultsmentioning

confidence: 99%

“…The majority of the studies (n = 28) used qualitative methods, eg, focus groups, semistructured interviews, and Delphi approach; one used mixed methods, 41 and 9 used quantitative methods. 44,48,51,52,57,58,65,68,69…”

Section: Searches Of Electronic Databases and The Reference Lists Of mentioning

confidence: 99%

“…61,71 For example, raising the topic of discontinuing a medication was initiated by only 18% of older adults in a Norwegian study, 68 while 55% had done so in a US study 51 and 42% in a Canadian study. 69 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. 69 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: Older Adult and Gp Characteristicsmentioning

confidence: 99%

“…69 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. 69 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. 42,61,71…”

Section: Older Adult and Gp Characteristicsmentioning

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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Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

et al. 2018

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and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing. OBJECTIVE To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes. DESIGN, SETTING, AND PARTICIPANTS For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients' Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%). MAIN OUTCOMES AND MEASURES Responses to 2 statements ("If my doctor said it was possible, I would be willing to stop one or more of my regular medicines" and "I would like to reduce the number of medicines I am taking") were the main outcomes of interest. RESULTS Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13). CONCLUSIONS AND RELEVANCE Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.

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

Cited by 40 publications

References 25 publications

Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

Older Patient and Caregiver Perspectives on Medication Value and Deprescribing: A Qualitative Study

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

Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

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