Attitudes Towards Deprescribing: The Perspectives of Geriatric Patients and Nursing Home Residents

Carina Lundby MScPharm, PhD; Peter Glans MScPharm; Trine Simonsen Pharmaconomist; Jens Søndergaard MD, PhD; Jesper Ryg MD, PhD; Henrik Hein Lauridsen DC, MSc, PhD; Anton Pottegård MScPharm, PhD

Disclosures

J Am Geriatr Soc. 2021;69(6):1508-1518. 

In This Article

Abstract and Introduction

Abstract

Background/Objectives: Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents.

Design: Interview-based questionnaire study.

Setting: Denmark.

Participants: Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8.

Measurements: Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics.

Results: Participants had a median age of 82 years (interquartile range [IQR] 76–89) and used a median of 8 medications (IQR 5–10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (p trend = 0.001): Those using 1–4 medications daily had a median score of 25 (IQR 17–33) compared to 58 (IQR 42–75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (p trend = 0.001) and a lower "appropriateness" score (p trend < 0.001), respectively.

Conclusion: Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

Introduction

Use of medication with questionable benefit is common in older people with frailty and/or limited life expectancy[1–3] and is associated with a number of harms, including adverse drug reactions, hospitalization, and mortality.[4] Deprescribing is increasingly recognized as a solution to such medication use and should therefore be systematically considered.[5] Successful deprescribing requires exploring patients' feelings about taking medication, discussing goals and treatment preferences, and addressing questions and concerns.[6] One way to explore patients' feelings about medication use is by use of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire,[7] which has been widely used to explore attitudes across patient populations.[8–11] However, while the majority of previous studies concern older people in general, only few studies assess the attitudes of older people with frailty and/or limited life expectancy[12] for whom deprescribing is particularly relevant. By use of the validated Danish version of the rPATD questionnaire,[13] we therefore aimed to explore geriatric patients' and nursing home residents' attitudes towards deprescribing.

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