Background and Goal: This study explored older adults' perspectives on proactive deprescribing, identified barriers and enablers, and developed a typology of patient attitudes to inform patient-centered deprescribing interventions.
Study Approach: In this qualitative study, researchers conducted semi structured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more oral medications.
Main Results:
Enablers
Negative valuation of medication: patients noted pill burden, possible harm and past success in stopping drugs.
Proactive decision making preference: a few patients wanted an active role and even started deprescribing talks.
Openness based on trust in the prescriber: many said they would cut back if a trusted clinician suggested it.
Barriers
Positive perspective on medication: satisfaction with current drugs or high expectations kept regimens unchanged.
Passive involvement and low perceived capability: patients deferred to doctors and felt unable to ask about deprescribing.
Caution driven by fear of change or comfort with the status quo: worry about symptom return discouraged stopping pills.
The researchers also developed a new typology with five types of patients: indifferent, satisfied and risk-averse, compliant, fearful but passive, and proactive.
Why it Matters: The findings from this study show that patients vary in their readiness to cut back on medications and underscore the importance of tailoring deprescribing discussions to each patient.
Proactive Deprescribing Among Older Adults With Polypharmacy: Barriers and Enablers
Kenya Ie, MD, MPH, PhD, et al
Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
