MedicalResearch.com Interview with:
Dr. Emily Reeve BPharm(Hons) PhD
NHMRC-ARC Dementia Research Fellow
Northern Clinical School
University of Sydney
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Older adults commonly take multiple medications. All medications carry the potential for both benefit and harm. When a medication is started a decision has been made between the healthcare professional and the patient that the likely benefits outweigh the potential risks. But over time the potential benefits and harms can change. So, part of good clinical care is discontinuation of medications when the benefit no longer outweighs the risks – for example when it is no longer needed or high risk. This is called “deprescribing”.
Previously we knew that older adults could have mixed feelings about their medications, that is, they believe that all their medications are necessary but also feel that they are a burden to them. Qualitative research has explored this further, finding that there are a number of barriers and enablers to deprescribing from the patient perspective. For example, someone might have fear of deprescribing because they are worried that their symptoms may come back. But if they know that deprescribing is a trial and they will be monitored and supported by their physician or other healthcare professional they might be more open to deprescribing.
From the physician perspective, there were concerns that older adults and their families were resistant to deprescribing and so there was fear that discussing possible medication discontinuation could damage the doctor-patient relationship.
In this study of almost 2000 older adults in the United States, we found that over 90% were willing to stop one of more of their medications if their doctor said it was possible. Additionally, one third of participants wanted to reduce the number of medications that they were taking.
MedicalResearch.com: What should readers take away from your report?
Response: The results of this study should reassure physicians and other healthcare professionals that older adults are open to the idea of deprescribing of one or more of their medications. It should also encourage them to regularly review medications and discuss deprescribing within the framework of patient-centered care and shared decision making.
The take home message for older adults is to talk to their physician and healthcare professionals about their medications. To not be afraid to ask, “Are there any of my medications that I don’t need anymore or might be risky?” I would encourage older adults and their families to be actively involved in discussions about medications and always ask questions if they are unsure or don’t understand.
Making sure that someone is taking the right medications at the right time involves both the expertise and knowledge of a healthcare professional and the lived experience and preferences of the patient.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: Further research is required to explore how to best support both healthcare professionals and patients to make decisions about deprescribing. For example, developing deprescribing guidelines and consumer information sheets. This will also contribute to the bigger questions of how to optimize deprescribing processes in regular clinical care.
No disclosures or conflicts of interest.
Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States. JAMA Intern Med. Published online October 15, 2018. doi:10.1001/jamainternmed.2018.4720
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