Attitudes of Older Adults and Caregivers in Australia toward Deprescribing

• Published in: Journal of the American Geriatrics Society (JAGS) 2019-06, Vol.67 (6), p.1204-1210
• Main Authors: Reeve, Emily, Low, Lee‐Fay, Hilmer, Sarah N.
• Format: Article
• Language: English
• Subjects: Adults; Aged; Attitude; Attitudes; Australia; Autonomy; Caregivers; Caregivers - psychology; deprescribing; Deprescriptions; Female; Health Knowledge, Attitudes, Practice; Humans; Male; medication; older adults; Older people; Physicians; Polypharmacy; Questionnaires; Surveys and Questionnaires
• ISSN: 0002-8614; 1532-5415
• DOI: 10.1111/jgs.15804

BACKGROUND/OBJECTIVES Use of harmful and/or unnecessary medications in older adults is common. Understanding older adult and caregiver attitudes toward deprescribing will contribute to medication optimization in practice. The aims of this study were to capture the attitudes and beliefs of older adults and caregivers toward deprescribing and determine what participant characteristics and/or attitudes (if any) predicted reported willingness to have a medication deprescribed. DESIGN Self‐completed questionnaire. SETTING Australia. PARTICIPANTS Older adults (n = 386), 65 years or older, taking one or more regular prescription medications and caregivers of older adults (n = 205) who could self‐complete a written questionnaire in English. MEASUREMENTS Older adult and caregiver versions of the validated revised Patients’ Attitudes Towards Deprescribing (rPATD) questionnaire were completed. The rPATD includes two global questions and four factors: perceived burden of medications, belief in appropriateness of medications, concerns about stopping, and involvement in medication management. Participant characteristics, self‐rated health, trust in physician, and health autonomy were also collected. RESULTS Older adult participants had a median age of 74 years (interquartile range [IQR] = 70‐81 y), and caregivers were aged 67 years (IQR = 59‐76) and were caring for a person aged 81 years (IQR = 75‐86.25 y). Most of both older adults (88%) and caregivers (84%) agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible. In a binary logistic regression model, a low concern about stopping factor score was the strongest predictor of willingness to have a medication deprescribed in older adults (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.04‐0.34). Excellent/good rating of physical health was the strongest predictor in caregivers (OR = 3.71; 95% CI = 1.13‐12.23). CONCLUSIONS Most older adults and caregivers are willing to have one of their or their care recipient's medication deprescribed, although different predictors (characteristics/attitudes) of this willingness were identified in these two groups.