In the Journals

Most older adults open to deprescribing

Emily Reeve 2018
Emily Reeve

More than 90% of older adults were willing to stop taking one or more medicines if they were reassured by their physician that it was possible, according to research published in JAMA Internal Medicine.

“Previous research found clinicians were concerned that older adults and their family were resistant to deprescribing. There was also fear reported that discussing possible medication discontinuation could damage the doctor-patient relationship,” Emily Reeve, PhD, clinical pharmacist from the Laboratory of Ageing and Pharmacology at the Royal North Shore Hospital, Australia, told Healio Internal Medicine.

Reeve and colleagues assessed the attitudes of Medicare beneficiaries aged 65 years and older (n = 1,981; 55.2% women) toward deprescribing and to determine if individual characteristics affected their attitude using data from in-person interviews that drew questions from the Patients’ Attitudes Towards Deprescribing questionnaire.

Main outcomes of interest included responses to “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.”

Data from the survey showed that most older adults (92%) indicated to cease use of one or more of their medications if their physician said it was feasible. About two-thirds of participants reported wanting to reduce the amount of medications they were .

The odds of being willing to stop one or more medications (adjusted OR = 2.9; 95% CI, 1.74-4.82) and wanting to decrease the number of medications (aOR = 2.31; 95% CI, 1.71-3.13) were greater among older adults taking six or more medications than those taking fewer than six medications.

“These findings do not mean that older adults and their families do not have concerns about deprescribing that need to be discussed and addressed,” Reeve said. “Instead, the findings should reassure clinicians that older adults are open to the idea of deprescribing and that, for many, deprescribing is in accordance with their goals and preferences. As such, it should also encourage them to regularly review medications and discuss deprescribing within the framework of shared decision making.”

Reeve noted that when approaching the topic of deprescribing with older patients, it can be helpful to explain that people change over time and that a medication that was appropriate when they were aged 65 years may not still be appropriate at age 80 years.

“There are a lot of factors that can change either the likely benefit or the possible harm that a medication can cause, such as new medical conditions or a new medication,” she said.

Physicians should explain to patients that they are reviewing their current medications to ensure that they are aligned with their current goals of care, she said.

“When discussing deprescribing with older adults, there are several key points that we recommend clinicians cover,” Reeve said. “This includes explaining why the medication is suitable for deprescribing, such as if they no longer need the medication, or if it might be causing a side effect. Additionally, older adults want to know how the medication will be withdrawn and that they will be monitored and supported throughout the process.”

“Finally, it’s important to address any fears that they may have about deprescribing, such as fear that their symptoms will come back,” she continued. “This could be done, for example, by explaining that withdrawal is a trial and the medication can be restarted if appropriate.”

It is often essential to bring caregivers into deprescribing discussions, she said, particularly when the patient cannot make informed decisions anymore.

“Caregivers want to know the same information as you would give to the patient,” Reeves said. “But, also, they may be feeling extra uncertainty about making the decision and weight of potential consequences. Here, again this could be addressed by discussing any potential fears they have and providing support throughout the process.” – by Alaina Tedesco

 

Disclosures: The authors report no relevant financial disclosures.

 

 

Emily Reeve 2018
Emily Reeve

More than 90% of older adults were willing to stop taking one or more medicines if they were reassured by their physician that it was possible, according to research published in JAMA Internal Medicine.

“Previous research found clinicians were concerned that older adults and their family were resistant to deprescribing. There was also fear reported that discussing possible medication discontinuation could damage the doctor-patient relationship,” Emily Reeve, PhD, clinical pharmacist from the Laboratory of Ageing and Pharmacology at the Royal North Shore Hospital, Australia, told Healio Internal Medicine.

Reeve and colleagues assessed the attitudes of Medicare beneficiaries aged 65 years and older (n = 1,981; 55.2% women) toward deprescribing and to determine if individual characteristics affected their attitude using data from in-person interviews that drew questions from the Patients’ Attitudes Towards Deprescribing questionnaire.

Main outcomes of interest included responses to “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.”

Data from the survey showed that most older adults (92%) indicated to cease use of one or more of their medications if their physician said it was feasible. About two-thirds of participants reported wanting to reduce the amount of medications they were .

The odds of being willing to stop one or more medications (adjusted OR = 2.9; 95% CI, 1.74-4.82) and wanting to decrease the number of medications (aOR = 2.31; 95% CI, 1.71-3.13) were greater among older adults taking six or more medications than those taking fewer than six medications.

“These findings do not mean that older adults and their families do not have concerns about deprescribing that need to be discussed and addressed,” Reeve said. “Instead, the findings should reassure clinicians that older adults are open to the idea of deprescribing and that, for many, deprescribing is in accordance with their goals and preferences. As such, it should also encourage them to regularly review medications and discuss deprescribing within the framework of shared decision making.”

Reeve noted that when approaching the topic of deprescribing with older patients, it can be helpful to explain that people change over time and that a medication that was appropriate when they were aged 65 years may not still be appropriate at age 80 years.

“There are a lot of factors that can change either the likely benefit or the possible harm that a medication can cause, such as new medical conditions or a new medication,” she said.

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Physicians should explain to patients that they are reviewing their current medications to ensure that they are aligned with their current goals of care, she said.

“When discussing deprescribing with older adults, there are several key points that we recommend clinicians cover,” Reeve said. “This includes explaining why the medication is suitable for deprescribing, such as if they no longer need the medication, or if it might be causing a side effect. Additionally, older adults want to know how the medication will be withdrawn and that they will be monitored and supported throughout the process.”

“Finally, it’s important to address any fears that they may have about deprescribing, such as fear that their symptoms will come back,” she continued. “This could be done, for example, by explaining that withdrawal is a trial and the medication can be restarted if appropriate.”

It is often essential to bring caregivers into deprescribing discussions, she said, particularly when the patient cannot make informed decisions anymore.

“Caregivers want to know the same information as you would give to the patient,” Reeves said. “But, also, they may be feeling extra uncertainty about making the decision and weight of potential consequences. Here, again this could be addressed by discussing any potential fears they have and providing support throughout the process.” – by Alaina Tedesco

 

Disclosures: The authors report no relevant financial disclosures.