Older adults' attitudes toward deprescribing in 14 countries

Abstract

Importance: Better understanding of patients’ attitudes toward deprescribing specific medications will inform future deprescribing interventions.

Objective: To investigate older adults’ attitudes toward deprescribing by investigating which medications they would like to have deprescribed, the reasons why, and patient factors associated with interest in deprescribing.

Design, Setting, and Participants: This survey study was conducted from May 2022 to December 2023 in primary care settings in 14 countries. Patients aged 65 years or older taking 5 or more medications were consecutively recruited by their general practitioner (GP) and completed the questionnaire.

Exposures: Patient characteristics, including gender, number of medications, GP gender, education level, financial status, confidence in completing medical forms, self-rated health, satisfaction with medications, trust in the GP, and country.

Main Outcomes and Measures: The primary outcomes were patient attitudes toward deprescribing specific medications, as measured by responses to the question, “Thinking about your current medication list, are there any medications that you would like to stop taking or reduce the dose of?” Multilevel multivariable logistic regression analysis was used, adjusted for clustering effect at the country level, to investigate the association between patient characteristics and interest in deprescribing.

Results: Of 1340 patients (mean [SD], 96 [47] patients per country), 736 (55%) were women, 580 (44%) had secondary school as their highest level of education, 1089 (82%) were satisfied with their medications, and 589 (44%) expressed they would like to deprescribe 1 or more of their medications. Patients expressed interest in deprescribing specific medications at varying levels, from 79% (86 of 109 patients) in Poland to 23% (21 of 96 patients) in Bulgaria. The 3 most reported medications patients would like to have deprescribed were diuretics (111 of 1002 medications [11%]), lipid-modifying agents (109 of 1002 medications [11%]), and agents acting on the renin-angiotensin system (83 of 1002 medications [8%]). The odds of naming at least 1 specific medication for deprescribing were lower for patients with higher medication satisfaction (odds ratio, 0.31; 95% CI, 0.21-0.47) and for patients with higher trust in their GP (odds ratio, 0.960; 95% CI, 0.930-0.998).

Conclusions and Relevance: In this survey study with primary care patients aged 65 years and older, patient attitudes toward deprescribing specific medications varied across countries, demonstrating that deprescribing interventions could be more impactful when adapted to specific settings and contexts. These findings highlight the importance of patient-practitioner communication in ensuring appropriate medication use.