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Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation

Weir KR, Shang J, Choi J, Rana R, Vordenberg SE. Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation. JAMA Netw Open. 2023 Oct 2;6(10):e2337281. doi: 10.1001/jamanetworkopen.2023.37281. PMID: 37819657; PMCID: PMC10568363.

This investigation aimed to understand why older adults disagree with deprescribing recommendations from primary care physicians in hypothetical scenarios. The study cohort consisted of individuals aged 65 or older from the United Kingdom, the United States, Australia, and the Netherlands.

The study utilized an online survey that described a hypothetical vignette about Mrs. EF, a 76-year-old woman, and her primary care physician’s deprescribing recommendation to stop either lansoprazole or simvastatin. Using a 6-point Likert scale, participants rated their agreement with the physician’s recommendation to stop the medication, and those strongly disagreeing or disagreeing were asked to provide free text comments explaining their disagreement. The study performed a content analysis of these free-text responses.

The analyses involved 899 participants aged 65 and older, with a mean age of 72 years and 51% men. Findings revealed that 40% of participants who disagreed with the physician’s deprescribing recommendation in the vignette had doubts about deprescribing (e.g., feared worsening symptoms or health that might arise from deprescribing), 16% valued the medication (e.g., feeling it was important or unnecessary), and 15% preferred avoiding change (e.g., expressing a preference to maintain the status quo). Valuing medications was more common among those who strongly disagreed compared to those who disagreed. Participants also noted strategies that might increase their willingness to consider deprescribing, expressing interest in improved communication, alternative strategies, and consideration of medication preferences. Those who disagreed, as opposed to strongly disagreed, were more open to additional communication and alternative strategies.

The study emphasizes tailoring patient-centered communication based on the degree of disagreement. While the study provides valuable insights, limitations include reliance on hypothetical vignettes and potential oversimplification as participants were not asked about their medical conditions, which may have affected their responses. Nevertheless, understanding older adults’ perspectives on deprescribing may significantly improve communication and enhance patient receptivity to recommendations.

Author Kristie Weir ponders the effectiveness of specific communication approaches identified by participants in addressing their concerns about deprescribing. This reflection comes in light of the study’s emphasis on the crucial role of tailored communication based on the degree of disagreement:

“Some older adults have a very strong preference to continue their medications. In this case, it may be best to limit deprescribing conversations to times when stopping a medication is necessary. However, other older adults need more information or reassurance about the process before agreeing to deprescribe a medication. It is not possible to cover all potential information in a short clinic visit. Therefore, clinicians may find value in asking open-ended questions so they can provide information that is the most important for patients as they consider deprescribing a medication.

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