Most Older Patients OK With Deprescribing

Troy Brown, RN

October 15, 2018

The vast majority (92%) of older adults said they would be willing to stop taking at least one of their medications if their physician said this was possible, according to a survey of almost 2000 Medicare beneficiaries. 

In addition, two thirds of respondents said they wanted to decrease the number of medications they were taking and most said they do not find it stressful when changes are made to their medications.

"To our knowledge, this is the first nationally representative study of attitudes toward deprescribing among older Medicare beneficiaries...This suggests that clinicians can be reassured about broaching the topic of deprescribing with their older patients," the researchers write.

Emily Reeve, PhD, from the National Health and Medical Research Council Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia, and colleagues published their findings online today in JAMA Internal Medicine.

The researchers analyzed data from the National Health and Aging Trends Study, a nationally representative survey of US Medicare beneficiaries aged 65 years and older; round six of the study comprised in-person interviews from the 10-item Medication Attitudes module that used questions from the Patients' Attitudes Toward Deprescribing questionnaire and a revised version of it.

The investigators randomly selected one third (2124) of participants from the National Health and Aging Trends Study to answer questions from the Medication Attitudes module (weighted response rate, 94.8%) and the current analysis included 1981 participants. Just over half (55.2%, weighted; n = 1149) of study participants were women and 54.6% (weighted; n = 715) were aged 65 to 74 years.

The primary outcomes of interest were respondents' answers to the following two 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."

Most respondents (92.0%, weighted; n = 1752) were willing to discontinue at least one of their medications with the permission of their physician, and 1241 (66.6%, weighted) said they wanted to reduce the number of medications they were taking.

Almost half of respondents (43.7%; n = 850) agreed or strongly agreed that they believed they were taking a large number of medications. Most (89.5%; n = 1702) agreed or strongly agreed that they needed all of their medications, whereas 16.1% (n = 333) agreed or strongly agreed that at least one of their medications was no longer needed.

"These seemingly contradictory beliefs (ie, being willing to have a medication deprescribed but also thinking that their medicines are necessary) may reflect a combination of traditional deference to physician recommendations coupled with a medical culture focused on prescribing and starting medications rather than deprescribing," the authors write.

Respondents were shown a series of photographs and asked about the maximum number of pills they would be comfortable taking, and 51.9% (n = 973) chose the option with the smallest number of pills, four. One quarter (25.4%; n = 486) chose the second-lowest option of eight pills. Thirteen percent of participants selected an option in which the photograph showed a smaller number of medications than they were currently taking.

Which Patients Were Most Willing to Stop?

After adjusting for demographic and clinical characteristics, those who were taking at least six medications were more likely to be willing to stop at least one medication vs those taking fewer than six (adjusted odds ratio [aOR], 2.90; 95% CI, 1.74 - 4.82). Older adults with two to three medical conditions (aOR, 2.87; 95% CI, 1.75 - 4.69) and more than three medical conditions (aOR, 2.87; 95% CI, 1.53 - 5.37) were almost three times more likely to be willing to drop medications compared with respondents with fewer than two medical conditions.

Compared with non-Hispanic white participants, non-Hispanic blacks (aOR, 0.60; 95% CI, 0.37 - 0.96) and those of other races (aOR, 0.46; 95% CI, 0.24 - 0.89) had lower odds of being willing to stop. Those with fair or poor health (aOR, 0.46; 95% CI, 0.24 - 0.86) were also less likely to report willingness to stop compared with participants reporting excellent or very good health.

The oldest adults (aged 85 years and older) (aOR, 0.61; 95% CI, 0.43 - 0.86) had lower odds of wanting to reduce medications compared with those aged 65 to 74 years. Respondents with dementia (aOR, 0.47; 95% CI, 0.32 - 0.71) were also less likely to want to stop medications compared with those without dementia.

"This new knowledge must be placed within the context of the wider fields of deprescribing and appropriate prescribing, such as the potential benefits and harms of deprescribing, determining which medications are appropriate to deprescribe in the individual, how physicians can be supported in deprescribing, and how the wider healthcare system and governing policies can be used to optimize medication use in older Americans," the authors explain.

"Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having one or more of their medicines stopped if their physician said it was possible, and two thirds want to reduce the number of medicines that they are taking," they conclude.

The authors have disclosed no relevant financial relationships.

JAMA Int Med. Published online October 15, 2018. Abstract

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