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Original Investigation
Less Is More
December 2018

Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States

Author Affiliations
  • 1National Health and Medical Research Council Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
  • 2Geriatric Medicine Research, Dalhousie University and Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
  • 3College of Pharmacy, Dalhousie University, Halifax, Nova Scotia, Canada
  • 4Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 5Center for Transformative Geriatric Research, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 6Institute for Health Research, Kaiser Permanente Colorado, Aurora
  • 7Department of Family Medicine, University of Colorado School of Medicine, Aurora
  • 8Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, St Leonards, New South Wales, Australia
JAMA Intern Med. 2018;178(12):1673-1680. doi:10.1001/jamainternmed.2018.4720
Key Points

Question  What are the attitudes of older Americans toward deprescribing?

Findings  In this population-based study of a nationally representative sample of older Medicare beneficiaries, 92.0% reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 66.6% wanted to reduce the number of medicines that they were taking. Characteristics of older adults that were related to these attitudes included number of medications taken and number of medical conditions.

Meaning  Physicians should be reassured that most older patients are open to deprescribing their medications within the framework of patient-centered care and shared decision making.

Abstract

Importance  Use of harmful and/or unnecessary medications in older adults is prevalent. This can lead to avoidable harms such as adverse drug reactions, falls, hospitalization, and mortality. Primary care physicians report that patient resistance to discontinuing medication use is a significant barrier to deprescribing.

Objective  To describe the attitudes of older adults toward deprescribing and to determine whether individual characteristics are associated with these attitudes.

Design, Setting, and Participants  For this population-based survey study of US Medicare beneficiaries 65 years and older, data were obtained from the Medication Attitudes module fielded through in-person interviews in round 6 of the National Health and Aging Trends Study (weighted response rate of round 6 was 88.5%). The questions in this module were drawn from the Patients’ Attitudes Towards Deprescribing questionnaire and its revised version. The Medication Attitudes module was fielded to a random one-third (n = 2124) of the National Health and Aging Trends Study participants (weighted response rate of this module was 94.8%).

Main Outcomes and Measures  Responses to 2 statements (“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”) were the main outcomes of interest.

Results  Of the 1981 Medicare beneficiaries included in the study, 1149 (55.2%, weighted) were women, and the majority (n = 715 [54.6%, weighted]) were 65 to 74 years old. A total of 1752 (92.0%, weighted) older adults reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 1241 (66.6%, weighted) older adults wanted to reduce the number of medicines that they were taking. Older adults taking 6 or more medications had greater odds than those taking fewer than 6 medications of being willing to stop taking 1 or more of their medicines (adjusted odds ratio, 2.90; 95% CI, 1.74-4.82) and wanting to reduce the number of medicines that they were taking (adjusted odds ratio, 2.31; 95% CI, 1.71-3.13).

Conclusions and Relevance  Physicians considering deprescribing as part of comprehensive, patient-centered care should be reassured that a majority of older Americans are open to having 1 or more of their medicines deprescribed if their physician says it is possible, and more than two-thirds want to reduce the number of medicines that they are taking.

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