Potentially inappropriate medication and attitudes of older adults towards deprescribing

Abstract

Introduction Multimorbidity and polypharmacy are current challenges when caring for the older population. Both have led to an increase of potentially inappropriate medication (PIM), illustrating the need to assess patients’ attitudes towards deprescribing. We aimed to assess the prevalence of PIM use and whether this was associated with patient factors and willingness to deprescribe. Method We analysed data from the LESS Study, a cross-sectional study on self-reported medication and on barriers and enablers towards the willingness to deprescribe (rPATD questionnaire). The survey was conducted among multimorbid (≥3 chronic conditions) participants ≥70 years with polypharmacy (≥5 long-term medications). A subset of the Beers 2019 criteria was applied for the assessment of medication appropriateness. Results Data from 300 patients were analysed. The mean age was 79.1 years (SD 5.7). 53% had at least one PIM (men: 47.8%%, women: 60.4%%; p = 0.007). A higher number of medications was associated with PIM use (p = 0.002). We found high willingness to deprescribe in both participants with and without PIM. Willingness to deprescribe was not associated with PIM use (p = 0.25), nor number of PIMs (p = 0.81). Conclusion The willingness of older adults with polypharmacy towards deprescribing was not associated with PIM use in this study. These results suggest that patients may not be aware if they are taking PIMs. This implies the need for raising patients’ awareness about PIMs through education, especially in females, in order to implement deprescribing in daily practice.

Inappropriate Medication and Perception of Quality of Life in Hospitalized Elderly Patients

“…Overall inappropriate prescribing values are similar by some studies [10,11]. It is important to note that this study demonstrated a strong association between inappropriate medication with positive STOPP criteria and the perception of a deterioration in quality of life, because a person who receives inappropriate medication increases 2.3 times the chance of perceiving a deterioration in their quality of life.…”

Older people’s attitudes towards deprescribing cardiometabolic medication

“…When health care providers want to discuss deprescribing cardiometabolic medication, it is important to address the perceived appropriateness of the specific medication. Even more so because willingness to deprescribe may not be associated with actual potential inappropriate medication use, indicating that patients are not necessarily aware of which medication is inappropriate [ 28 ]. Particularly, an explanation may be needed why medication that was appropriate for the patient in the past, is no longer required or can even be harmful.…”

“…The number of medications was associated with some of the attitudes favoring deprescribing [ 30 ]. The use of potentially inappropriate medication did not seem to be associated with the willingness to deprescribe [ 28 ]. So far, studies have not investigated differences in attitudes of patients using different kinds of preventive medications, such as diabetes or cardiovascular medication.…”

Associated factors with the prescription of potentially inappropriate medication for older adult in a public hospital

“…36,33 De forma geral, sugere-se que o alto índice de prescrições e utilizações inadequadas desses medicamentos pelas mulheres, seja mais elevado tanto epidemiologicamente, pela maior susceptibilidade ao aparecimento de DCNT, quanto em termos comportamentais, pela sua maior procura aos serviços de saúde, em comparação com os homens. 33,37 No tocante aos diagnósticos, as DCNTs são desenvolvidas com o aumento da idade, principalmente as doenças que acometem o aparelho circulatório e as doenças endócrinas, nutricionais e metabólicas, como por exemplo Hipertensão, Diabetes e outras complicações cardiovasculares, as quais representam uma média de 80% no Brasil, induzem a uma prescrição extensa e complexa para os idosos. 38,39 Nesse sentido, a utilização de algum MPI, em indivíduos com alterações orgânicas importantes inerentes a idade, impactam tanto no agravamento destes diagnósticos quanto afetam os processos farmacocinéticos e farmacodinâmicos, podendo ocasionar maior exposição aos eventos adversos.…”

“…31,32 Com relação a polifarmácia, estudos anteriores corroboram com esse achado, nos quais houve relatos de prevalências que variaram entre 97,1% e 100%. 33,34 Não obstante a prática da polifarmácia seja bastante utilizada como medida clínica, objetivando uma melhor resposta e adesão ao tratamento, ela indica uma ameaça para a saúde do idoso, o que pode contribuir com os altos índices de mortalidade. 35,7 Dentre os fatores que obtiveram associação significativa com o uso de MPI nesta população, cabe destacar que a proporção de mulheres foi essencialmente maior que a dos homens, podendo explicar o fato de o sexo feminino estar mais exposto ao uso de MPI no presente estudo.…”