Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

Abstract

ImportanceLittle is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons.ObjectiveTo examine factors important to older adults who disagree with a deprescribing recommendation given by a primary care physician to a hypothetical patient experiencing polypharmacy.Design, Setting, and ParticipantsThis online, vignette-based survey study was conducted from December 1, 2020, to March 31, 2021, with participants 65 years or older in the United Kingdom, the US, Australia, and the Netherlands. The primary outcome of the main study was disagreement with a deprescribing recommendation. A content analysis was subsequently conducted of the free-text reasons provided by participants who strongly disagreed or disagreed with deprescribing. Data were analyzed from August 22, 2022, to February 12, 2023.Main Outcomes and MeasuresAttitudes, beliefs, fears, and recommended actions of older adults in response to deprescribing recommendations.ResultsOf the 899 participants included in the analysis, the mean (SD) age was 71.5 (4.9) years; 456 participants (50.7%) were men. Attitudes, beliefs, and fears reported by participants included doubts about deprescribing (361 [40.2%]), valuing medications (139 [15.5%]), and a preference to avoid change (132 [14.7%]). Valuing medications was reported more commonly among participants who strongly disagreed compared with those who disagreed with deprescribing (48 of 205 [23.4%] vs 91 of 694 [13.1%], respectively; P < .001) or had personal experience with the same medication class as the vignette compared with no experience (93 of 517 [18.0%] vs 46 of 318 [12.1%], respectively; P = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), and consideration of medication preferences (137 [15.2%]) may increase their agreement with deprescribing. Participants who disagreed compared with those who strongly disagreed were more interested in additional communication (196 [28.2%] vs 29 [14.2%], respectively; P < .001), alternative strategies (117 [16.9%] vs 21 [10.2%], respectively; P = .02), or consideration of medication preferences (122 [17.6%] vs 15 [7.3%], respectively; P < .001).Conclusions and RelevanceIn this survey study, older adults who disagreed with a deprescribing recommendation were more interested in additional communication, alternative strategies, or consideration of medication preferences compared with those who strongly disagreed. These findings suggest that identifying the degree of disagreement with deprescribing could be used to tailor patient-centered communication about deprescribing in older adults.

Older adults’ attitudes towards deprescribing and medication changes: a longitudinal sub-study of a cluster randomised controlled trial

“…From the main OPTICA trial, the most common reasons for not implementing prescribing recommendations were that GPs thought that patients’ current medications were beneficial and that the recommended change was not suitable. The first study to focus on older adults from multiple countries who disagree with a deprescribing recommendation in a vignette-based survey (n=899) 46 found that older adults reported valuing their medications, they expressed doubts about deprescribing, and preferred to avoid change. Respondents who disagreed with the deprescribing recommendation, as opposed to those who strongly disagreed, were more interested in alternative strategies such as improved communication or a replacement medication.…”

Older adults' adherence to medications and willingness to deprescribe: A substudy of a randomized clinical trial

“…A person's beliefs and attitudes towards their medications play a key role in how willing they are to start, continue or stop taking a medication 12,13 . Adherence and deprescribing are both influenced by the following patient‐related factors about medications: positive or negative attitudes, beliefs about the potential impact, perceived necessity and importance and fears or concerns about the medication and/or the health condition 4,13–16 …”