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

Abstract

Background: People with dementia (PWD) take medications that may be unnecessary or harmful. This problem can be addressed through deprescribing, but it is unclear if PWD would be willing to engage in deprescribing with their providers. Our goal was to investigate attitudes toward deprescribing among PWD.

Methods: This was a cross-sectional study of 422 PWD aged ≥65 years who completed the medications attitudes module of the National Health and Aging Trends Study (NHATS) in 2016. Proxies provided responses when a participant was unable to respond due to health or cognitive problems. Attitudinal outcomes comprised responses to two statements from the patients' attitudes toward deprescribing questionnaire and its revised version (representing belief about the necessity of one's medications and willingness to deprescribe); another elicited the maximum number of pills that a respondent would be comfortable taking.

Results: The weighted sample represented over 1.8 million PWD; 39% were 75 to 84 years old and 38% were 85 years or older, 60% were female, and 55% reported six or more regular medications. Proxies provided responses for 26% of PWD. Overall, 22% believed that they may be taking one or more medicines that they no longer needed, 87% were willing to stop one or more of their medications, and 50% were uncomfortable taking five or more medications. Attitudinal outcomes were similar across sociodemographic and clinical factors. PWD taking ≥6 medications were more likely to endorse a belief that at least one medication was no longer necessary compared to those taking <6 (adjusted probability 29% [95% confidence interval (CI), 22%-38%] vs. 13% [95% CI, 8%-20%]; p = 0.004); the same applied for willingness to deprescribe (92% [95% CI, 87%-95%] vs. 83% [95% CI, 76%-89%]; p = 0.04).

Conclusions: A majority of PWD are willing to deprescribe, representing an opportunity to improve quality of life for this vulnerable population.

Keywords: attitudes; dementia; deprescribing; medications.

Figure 1:

Overlap of Attitudes Toward Medications and Deprescribing Among Older Adults with Dementia Legend: Each of the 3 ellipses in the Venn diagram corresponds to one of the attitudinal outcomes (belief about necessity of one’s medications, willingness to deprescribe, and discomfort with polypharmacy). The sample giving rise to the Figure comprises subjects who responded to all 3 outcome questions (N=360). In this sample, 25% endorsed believing that they may be taking one or more medicines that they no longer needed, 88% endorsed willingness to stop one or more of their regular medications if a doctor said it was possible, and 49% endorsed being uncomfortable taking 5 or more medications. The percentages incorporate NHATS analytic survey weights, are rounded to the nearest integer, and reflect the proportions of the sample who agreed to various combinations of the outcome prompts. Five percent of the sample who disagreed with all 3 prompts are not depicted; due to these factors as well as rounding, the depicted percentages do not sum to 100%.

Figure 2:

Predictors of Medication Attitudes Among Older Adults with Dementia Legend: Predictors are organized vertically along the left-hand side; attitudinal outcomes are listed at the bottom and organized into three columns. Point estimates represent the adjusted probability of each attitudinal outcome across strata of the predictors, along with 95% confidence intervals. Results are adjusted for weights and survey design to provide nationally representative estimates. Coloring of the bars is to help with ease of viewing of different levels between covariates. Marginal predicted probabilities were estimated via multivariable logistic regression models with adjustment for adjustment for age, sex, chronic conditions, dementia status (possible or probable), proxy status (self-respondent or proxy), and number of medications. Blue background shading denotes predictors associated with attitudinal outcomes at the p<0.05 level based on an F-test examining the overall effect of the predictor of interest when added to a regression model containing the previously mentioned covariates.