Green AR, Aschmann H, Boyd CM, Schoenborn N. Association between willingness to deprescribe and health outcome priorities among U.S. older adults: Results of a national survey [published online ahead of print, 2022 Jun 6]. J Am Geriatr Soc. 2022;10.1111/jgs.17917. doi:10.1111/jgs.17917
A team led by Dr. Ariel Green, who received a pilot award from the US Deprescribing Research Network, recently published a clinical investigation in JAGS on the association between willingness to deprescribe and health outcome priorities among older adults. A 2020 cross-sectional survey of older adults’ responses to two scenarios informed this study:
- Preventive medicine scenario: Respondents are asked about their willingness to deprescribe a statin being used for primary prevention that may cause side effects such as muscle pain or weakness, nausea, constipation, diarrhea, and drug interactions.
- Symptom-relief medicine scenario: Respondents are asked about their willingness to deprescribe a sedative-hypnotic being used for insomnia that may cause side effects such as falls, memory issues, hospitalization, and death.
In addition to addressing these two scenarios, respondents rated their agreement with two health outcome prioritization statements:
- Quantity vs. quality of life: “I would prefer to take fewer medicines, even it meant that I may not live as long or may have bothersome symptoms sometimes.”
- Current vs. future health: “I am willing to accept the risk of future side effects, such as falls or memory problems, to feel better now.”
Researchers then assessed the association between 1) health outcome prioritizes and respondent characteristics and 2) willingness to deprescribe and health outcome priorities, accounting for respondent characteristics. Their findings were:
- Most older adults were willing to deprescribe if their doctor recommended it
- Willingness to deprescribe aligned with health outcome priorities
- More older adults were willing to stop preventive medicines compared to symptom-relief medicines, although many were willing to stop both types.
Future research should focus on the identification of patient health outcome priorities, which may help guide deprescribing conversations.
Dr. Green explains further:
“For example, we are currently wrapping up a pilot study in which a clinical pharmacist asks these questions of older adults and uses this information to guide deprescribing recommendations. Another approach might be to provide primary care providers with brief scripts to give them the language to have these kind of conversations, and educational materials to show them how patient health outcome priorities can inform deprescribing.”