Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

doi:10.1111/jgs.17054

. 2021 Jun;69(6):1508-1518.

doi: 10.1111/jgs.17054. Epub 2021 Feb 17.

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Carina Lundby^{1

2

3

4

5}, Peter Glans¹, Trine Simonsen¹, Jens Søndergaard^{4

5}, Jesper Ryg^{5

6

7}, Henrik Hein Lauridsen⁸, Anton Pottegård^{1

3

5}

Affiliations

¹ Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.
² OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.
³ Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
⁴ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
⁵ ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark.
⁶ Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark.
⁷ Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.
⁸ Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.

PMID: 33598916
DOI: 10.1111/jgs.17054

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

Carina Lundby et al. J Am Geriatr Soc. 2021 Jun.

. 2021 Jun;69(6):1508-1518.

doi: 10.1111/jgs.17054. Epub 2021 Feb 17.

Authors

Carina Lundby^{1

2

3

4

5}, Peter Glans¹, Trine Simonsen¹, Jens Søndergaard^{4

5}, Jesper Ryg^{5

6

7}, Henrik Hein Lauridsen⁸, Anton Pottegård^{1

3

5}

Affiliations

¹ Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.
² OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.
³ Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
⁴ Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
⁵ ODIN, Odense Deprescribing INitiative, Odense University Hospital and University of Southern Denmark, Odense C, Denmark.
⁶ Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark.
⁷ Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.
⁸ Research Unit of Clinical Biomechanics, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.

PMID: 33598916
DOI: 10.1111/jgs.17054

Abstract

Background/objectives: Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents.

Design: Interview-based questionnaire study.

Setting: Denmark.

Participants: Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8.

Measurements: Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics.

Results: Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (p_trend = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (p_trend = 0.001) and a lower "appropriateness" score (p_trend < 0.001), respectively.

Conclusion: Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

Keywords: attitudes; deprescribing; geriatric patients; nursing home residents.

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References

REFERENCES

1. Lundby C, Jensen J, Larsen SP, Hoffmann H, Pottegård A, Reilev M. Use of medication among nursing home residents: a Danish drug utilisation study. Age Ageing. 2020;49(5):814-820. https://doi.org/10.1093/ageing/afaa029.
1. Poudel A, Yates P, Rowett D, Nissen LM. Use of preventive medication in patients with limited life expectancy: a systematic review. J Pain Symptom Manage. 2017;53(6):1097-1110.e1. https://doi.org/10.1016/j.jpainsymman.2016.12.350.
1. Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1-862.e9. https://doi.org/10.1016/j.jamda.2016.06.011.
1. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660.
1. Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. https://doi.org/10.1001/jamainternmed.2015.0324.

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[1] Lundby C, Jensen J, Larsen SP, Hoffmann H, Pottegård A, Reilev M. Use of medication among nursing home residents: a Danish drug utilisation study. Age Ageing. 2020;49(5):814-820. https://doi.org/10.1093/ageing/afaa029.

[2] Lundby C, Jensen J, Larsen SP, Hoffmann H, Pottegård A, Reilev M. Use of medication among nursing home residents: a Danish drug utilisation study. Age Ageing. 2020;49(5):814-820. https://doi.org/10.1093/ageing/afaa029.

[3] Poudel A, Yates P, Rowett D, Nissen LM. Use of preventive medication in patients with limited life expectancy: a systematic review. J Pain Symptom Manage. 2017;53(6):1097-1110.e1. https://doi.org/10.1016/j.jpainsymman.2016.12.350.

[4] Poudel A, Yates P, Rowett D, Nissen LM. Use of preventive medication in patients with limited life expectancy: a systematic review. J Pain Symptom Manage. 2017;53(6):1097-1110.e1. https://doi.org/10.1016/j.jpainsymman.2016.12.350.

[5] Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1-862.e9. https://doi.org/10.1016/j.jamda.2016.06.011.

[6] Morin L, Laroche M-L, Texier G, Johnell K. Prevalence of potentially inappropriate medication use in older adults living in nursing homes: a systematic review. J Am Med Dir Assoc. 2016;17(9):862.e1-862.e9. https://doi.org/10.1016/j.jamda.2016.06.011.

[7] Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660.

[8] Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13(1):57-65. https://doi.org/10.1517/14740338.2013.827660.

[9] Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. https://doi.org/10.1001/jamainternmed.2015.0324.

[10] Scott IA, Hilmer SN, Reeve E, et al. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175(5):827-834. https://doi.org/10.1001/jamainternmed.2015.0324.

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Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

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Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents

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Abstract

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