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

Discussion

In a large sample of geriatric inpatients, geriatric outpatients, and nursing home residents, we found that most patients would be willing to stop one of their regular medications on their physician's advice; however, only one third reported an intrinsic desire to do so.

Strengths and Limitations

The principal strength of this study is the inclusion of three older populations, allowing us to explore differences in attitudes towards deprescribing across different patient populations. The main limitation is related to the participant recruitment. Based on a subjective consideration of general health and cognitive function, geriatric inpatients and nursing home residents were initially identified by nursing staff as willing and seemingly able to participate in the study, after which participants were screened for study eligibility using the OMC test.[14] Consequently, the OMC scores are higher than normally seen in these populations[15,16] which might limit generalizability of results to all Danish geriatric inpatients and nursing home residents. However, that 9% (n = 32) were still excluded due to cognitive impairment during the eligibility screening indicates that the nursing staff have not been too selective in the initial screening. Further, as we only observed a minor effect of OMC scores (ranging from 8 to 28) on the "appropriateness" factor, this suggests that cognitive function may only to a limited extent affect attitudes towards deprescribing. Generalizability may also be influenced by recruitment of participants restricted to the Region of Southern Denmark and by the single center inclusion of geriatric patients. Finally, there is a risk that some nursing home residents may have been referred or admitted to the geriatric department following study inclusion and consequently offered study participation twice. However, as only 6% (n = 8) of the geriatric patients resided in nursing homes (data not shown), we believe the risk of double inclusion is negligible.

Comparison With Existing Literature

Our finding that most participants (89%) would be willing to stop one of their regular medications on their physician's advice is in accordance with previous literature.[8–12,21–23] Interestingly, only one third reported an intrinsic desire to try stopping one of their medications. This is consistent with a recent study reporting that 41% of residents in aged care facilities would like to reduce their number of medications, while this number was almost twice as high if suggested by their physician.[12] Recently, two qualitative studies found that a large proportion of nursing home residents were unaware of the possibility of taking less medication.[24,25] This may in part explain the lower intrinsic desire to stop a medication observed in this population. However, as lower intrinsic desire has also been reported in other populations of older people,[8,9,11,21] it may also be explained by the high physician trust among many older people, resulting in not questioning their physician's medical decisions.[24–27] Regardless, this highlights the importance of clinicians making older people aware of the possibility of deprescribing.

Across the three participant groups, the majority was satisfied with their current medications; however, participants also expressed great interest in deprescribing. Such conflicting attitudes have been extensively reported in the qualitative literature, where older people would like to reduce their number of medications but at the same time feel obliged to take them.[24,25,28–30]

The "concerns about stopping" score increased with an increasing number of medications, indicating that those taking more mediations also have more concerns about stopping them. A recent study found that older adults were less likely to be willing to have a medication deprescribed if they had concerns about stopping their medications,[9] suggesting that it may be more challenging to facilitate deprescribing among patients that could possibly benefit most from it, i.e., those with polypharmacy.

Implications for Clinical Practice and Research

Our results imply that attitudes towards deprescribing vary across populations of geriatric patients and nursing home residents, stressing the importance of addressing each patient individually and tailoring the deprescribing approach to the individual patient. Based on the limited knowledge of deprescribing as a possibility in these populations,[24,25] clinicians should remember to continuously make patients aware of this.

In conclusion, our study demonstrates that geriatric inpatients, geriatric outpatients, and nursing home residents are open towards deprescribing, particularly if proposed by the physician. Despite many similarities in attitudes between the populations, differences also exist, while attitudes are also affected by individual patient characteristics.

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