Attitudes and barriers towards deprescribing in older patients experiencing polypharmacy: a narrative review

npj Aging, Год журнала: 2024, Номер 10(1)

Опубликована: Янв. 23, 2024

Abstract Polypharmacy, commonly defined as ≥5 medications, is a rising public health concern due to its many risks of harm. One recommended strategy address polypharmacy medication reviews, with subsequent deprescription inappropriate medications. In this review, we explore the intersection older age, polypharmacy, and deprescribing in contemporary context by appraising published literature (2012–2022) identify articles that included new primary data on medications patients aged ≥65 years currently taking We found 31 were which describe current perceptions clinicians towards deprescribing, identified barriers, key enabling factors, future directions approaching deprescribing. Currently, believe complex process, despite majority reporting feeling comfortable fewer engage process regularly. Common barriers cited include lack knowledge training around time, breakdown communication, perceived ‘abandonment care’, fear adverse consequences, resistance from and/or their carers. factors recognition opportunities instigate regular improving lines education both multidisciplinary approach patient care. Addressing requires nuanced generally group patients. Key strategies reducing clinicians, addition communication between healthcare providers approach.

Язык: Английский

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Advancing the Science of Deprescribing: A Novel Comprehensive Conceptual Framework

Journal of the American Geriatrics Society, Год журнала: 2019, Номер 67(10), С. 2018 - 2022

Опубликована: Авг. 20, 2019

Polypharmacy is common in older adults and associated with inappropriate medication use, adverse drug events, nonadherence, higher costs, increased mortality compared those without polypharmacy. Deprescribing, the clinically supervised process of stopping or reducing dose medications when they cause harm no longer provide benefit, may improve outcomes. Although potentially beneficial, clinicians struggle to overcome structural, organizational, technological, cognitive barriers deprescribing, limiting its use clinical practice. Deprescribing science would benefit from a unifying conceptual framework prioritize research. Current deprescribing frameworks have made important contributions field but often focus on specific classes aspects deprescribing. To further this relatively nascent field, we developed broader that builds prior includes patient, prescriber, system influences; deprescribing; outcomes; dissemination. Patient factors include patients' biology, experience, values, preferences. Prescriber rational (eg, based explicit knowledge) nonrational behavioral tendencies, biases, heuristics) decision making. System resources, incentives, goals, culture contribute The separates . captures results by examining changes structures, performance processes, patient health outcomes, cost. Through testing refinement, novel, more comprehensive has potential advance research organizing existing evidence, identifying evidence gaps, categorizing interventions settings which are applied. J Am Geriatr Soc 67:2018–2022, 2019

Язык: Английский

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Older people’s attitudes towards deprescribing cardiometabolic medication

BMC Geriatrics, Год журнала: 2021, Номер 21(1)

Опубликована: Июнь 16, 2021

Overtreatment with cardiometabolic medication in older patients can lead to major adverse events. Timely deprescribing of these medications is therefore essential. Self-reported willingness stop usually high among people, still overtreatment common and rarely initiated. An important barrier for reported by general practitioners the patients' unwillingness medication. More insights are needed into influence characteristics on their attitudes towards differences between groups.A survey people using revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire was performed. Participants completed rPATD an adapted version four groups. Linear ordinal logistic regression were used assess age, sex, therapeutic area number deprescribing. Univariate analysis compare sulfonylureas, insulins, antihypertensive statins.Overall, 314 out 1143 invited participants (median age 76 years, 54% female). Most (80%) satisfied willing if doctor said it possible (88%). Age, sex had no Taking more than ten medicines significantly associated a higher perceived burden. Antihypertensive insulin considered appropriate statins, sulfonylureas not favouring deprescribing.The majority one possible. Health care providers should take account that perceive some as other when discussing

Язык: Английский

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Attitudes of older adults and their carers towards de‐prescribing: A systematic review

Diabetic Medicine, Год журнала: 2022, Номер 39(7)

Опубликована: Фев. 4, 2022

Abstract Aim The aim of this systematic review is to explore the attitudes older adults (≥65 years old) and their carers towards de‐prescribing. Methods We identified relevant studies from three databases; MEDLINE, CINAHL Web Science. Two reviewers (MS, SS) independently extracted data each selected study using a standardised self‐developed extraction form. Main findings were summarised descriptively. Results A total 35 included in review. Of them, 19 questionnaire studies, 11 semi‐structured interviews, 4 focus groups 1 used nominal group technique approach. Most willing have medication de‐prescribed if told do so by healthcare professional (HCP). Other factors that increased willingness de‐prescribing included; trust HCP, side effects inconvenience medications as well prospect follow‐up monitoring during In contrast, perceived effectiveness, unawareness lack benefit, negative expectations ageing fear preventing Conclusion De‐prescribing an important concept people given harm associated with polypharmacy age group. Overall, are facilitated HCP. However, there remain few barriers which may need be addressed certain patients, through discussions between adults/their allow more effective.

Язык: Английский

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Optimizing Medications with the Geriatrics 5Ms: An Age-Friendly Approach

Drugs & Aging, Год журнала: 2023, Номер 40(5), С. 391 - 396

Опубликована: Апрель 12, 2023

Язык: Английский

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Development of a Metric to Detect and Decrease Low-Value Prescribing in Older Adults

JAMA Network Open, Год журнала: 2022, Номер 5(2), С. e2148599 - e2148599

Опубликована: Фев. 15, 2022

Importance

Metrics that detect low-value care in common forms of health data, such as administrative claims or electronic records, primarily focus on tests and procedures but not medications, representing a major gap the ability to systematically measure prescribing.

Objective

To develop scalable broadly applicable metric contains set quality indicators (EVOLV-Rx) for use data reduce prescribing among older adults is informed by diverse stakeholders' perspectives.

Design, Setting, Participants

This qualitative study used an online modified-Delphi method convene expert panel 15 physicians pharmacists. panel, comprising clinicians, system leaders, researchers, was tasked with rating discussing candidate practices were derived from medication safety criteria; peer-reviewed literature; studies patient, caregiver, physician The RAND ExpertLens platform conduct activities panel. panelists engaged 3 rounds between January 1 March 31, 2021.

Main Outcomes Measures

Panelists 9-point Likert scale rate then discuss scientific validity clinical usefulness criteria practices. Candidate rated follows: 3, indicating low usefulness; 3.5 6, uncertain 6.5 9, high usefulness. Agreement degree assessed using RAND/UCLA (University California, Los Angeles) Appropriateness Method.

Results

Of 527 recommendations identified, 27 discrete considered inclusion EVOLV-Rx. After round 1, 18 having (scores ≥6.5). 2 deliberations, 19 revised. met criteria, receiving final median scores higher both those included version EVOLV-Rx, received ≥6.5) <6.5) ratings, whereas 6 <6.5).

Conclusions Relevance

culminated development EVOLV-Rx involved experts who identified most salient adults. Applying may enhance detection practices, polypharmacy, enable receive high-value across full spectrum services.

Язык: Английский

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Deprescribing interventions in older adults: An overview of systematic reviews

PLoS ONE, Год журнала: 2024, Номер 19(6), С. e0305215 - e0305215

Опубликована: Июнь 17, 2024

Objective The growing deprescribing field is challenged by a lack of consensus around evidence and knowledge gaps. objective this overview systematic reviews was to summarize the review for interventions in older adults. Methods 11 databases were searched from 1 st January 2005 16 th March 2023 identify reviews. We summarized synthesized results two steps. Step reported included (including meta-analyses). 2 involved narrative synthesis outcome. Outcomes medication-related outcomes ( e . g ., medication reduction, appropriateness) or twelve other mortality, adverse events). according subgroups (patient characteristics, intervention type setting) when direct comparisons available within quality assessed using A MeaSurement Tool Assess Reviews (AMSTAR 2). Results retrieved 3,228 unique citations 135 full-text articles eligibility. Forty-eight (encompassing 17 meta-analyses) included. Thirty-one 48 had general focus, focused on specific classes therapeutic categories one both. Twelve meta-analyzed (33 outcomes: 25 favored intervention, 7 found no difference, comparison). indicated that most resulted some reduction while we primarily an effect. mixed events few drug withdrawal events. Limited information people with dementia, frailty multimorbidity. All but scored low critically assessment. Conclusion Deprescribing likely outcomes, particular relating events, vulnerable settings limited. Future research should focus designing studies powered examine harms, patient-reported effects subgroups. Systematic Review Registration PROSPERO CRD42020178860

Язык: Английский

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Quality of prescribing and health-related quality of life in older adults: a narrative review with a special focus on patients with atrial fibrillation and multimorbidity

European Geriatric Medicine, Год журнала: 2025, Номер unknown

Опубликована: Март 9, 2025

Abstract Purpose To summarise the association between potentially inappropriate prescribing (PIP) and health-related quality of life (HRQOL) in older adults, with a special focus on those atrial fibrillation (AF) multimorbidity, while exploring potential interventions to improve their impact HRQOL. Methods A comprehensive search strategy was conducted MEDLINE using PubMed interface August 16th, 2024, focusing key terms related “potentially prescribing” “quality life”. Additionally, reference lists included studies were screened. Only utilising validated assessment tools for HRQOL or measuring global self-perceived health status considered. Studies involving populations an average age ≥ 65 years included. Results Of 1810 articles screened, 35 The findings indicate that prescribing, independent polypharmacy, may negatively influence review identified range aimed at improving among including pharmacist-driven, general practitioner-driven, multidisciplinary approaches. Interventions assessed distinct population groups specifically residential care homes. While some demonstrated improvements quality, overall evidence regarding remains limited. Conclusion relationship underexplored adults AF despite high prevalence PIP. Effective pharmacotherapy should be coupled patients' clinical functional parameters, considering Adopting multidisciplinary, integrated, patient-centred approach is essential sustainable appropriate practices enhance

Язык: Английский

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Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review

BMJ Open, Год журнала: 2022, Номер 12(12), С. e061686 - e061686

Опубликована: Дек. 1, 2022

To synthesise the current knowledge on barriers and facilitators to deprescribing cardiovascular medications (CVMs) at levels of patients, informal caregivers healthcare providers (HCPs).We conducted a systematic review studies exploring/assessing patient, caregiver and/or HCP CVMs.Ovid/MEDLINE Embase from January 2003 November 2021.We performed deductive thematic analysis based framework specific CVMs created by Goyal et al. We added quantification occurrence categories themes in selected articles identify resounding that indicate greater impetus address future research.Most frequent for HCPs included uncertainty due lack evidence regarding CVM (in n=10 studies), fear negative consequences following (n=13) social influences (n=14). A frequently reported facilitator deprescribing, especially patients caregivers, was adverse drug events (n=7). Another were dislike (n=9). Necessity benefit seen as or similarly HCPs.The differences stress need ground discussions about beliefs preferences each stakeholder implicated decisions. Furthermore, highlights provide with tools enable sharing risks benefits ensure safe process.CRD42020221973.

Язык: Английский

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Attitudes toward deprescribing among older adults with dementia in the United States

Journal of the American Geriatrics Society, Год журнала: 2022, Номер 70(6), С. 1764 - 1773

Опубликована: Март 10, 2022

Abstract Background People with dementia (PWD) take medications that may be unnecessary or harmful. This problem can addressed through deprescribing, but it is unclear if PWD would willing to engage in deprescribing their providers. Our goal was investigate attitudes toward among PWD. Methods a cross‐sectional study of 422 aged ≥65 years who completed the module National Health and Aging Trends Study (NHATS) 2016. Proxies provided responses when participant unable respond due health cognitive problems. Attitudinal outcomes comprised two statements from patients' questionnaire its revised version (representing belief about necessity one's willingness deprescribe); another elicited maximum number pills respondent comfortable taking. Results The weighted sample represented over 1.8 million PWD; 39% were 75 84 old 38% 85 older, 60% female, 55% reported six more regular medications. for 26% Overall, 22% believed they taking one medicines no longer needed, 87% stop medications, 50% uncomfortable five similar across sociodemographic clinical factors. ≥6 likely endorse at least medication necessary compared those <6 (adjusted probability 29% [95% confidence interval (CI), 22%–38%] vs. 13% CI, 8%–20%]; p = 0.004); same applied deprescribe (92% 87%–95%] 83% 76%–89%]; 0.04). Conclusions A majority are deprescribe, representing an opportunity improve quality life this vulnerable population.

Язык: Английский

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