Clinical question: Among older adults, what attitudes exist toward deprescribing?
Background: Polypharmacy in older adults is common and can be associated with increased hospitalizations and reduced quality of life.
Study design: Population-based survey study.
Setting: Medicare beneficiaries in the United States.
Synopsis: The investigators used data from the National Health and Aging Trends Study (NHATS), which collects information annually on a nationally representative sample of Medicare beneficiaries ages 65 and older. Of 1,981 responses on the NHATS Medication Attitudes module, 92% of older adults expressed willingness to stop a medication if their doctor said it was possible. While 89% agreed that all their medications were necessary, 66.6% also agreed that they would like to reduce the number of their medications. Patients taking more than six medications, compared with those taking fewer than six (adjusted odds ratio, 2.9; 95% confidence interval, 1.74-4.82) and those with three or more medical conditions, compared with patients with fewer than two (aOR 2.87; 95% CI 1.53-5.37) had greater odds of willingness to stop a medication. Importantly, the study did not collect data about specific medications.
Bottom line: A vast majority of older adults would be willing to stop one or more of their medications if considered possible by their physician, and two-thirds want to reduce the number of their medications. If appropriate, hospitalists should consider having a conversation about deprescribing with their older patients.
Citation: Reeve E et al. Assessment of attitudes toward deprescribing in older Medicare beneficiaries in the United States. JAMA Intern Med. 2018;178(12):1673-180.
Dr. Stanley is assistant professor of medicine at Northwestern University Feinberg School of Medicine and a hospitalist at Northwestern Memorial Hospital, both in Chicago.