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J Gerontol B Psychol Sci Soc Sci. 2018 Sep 20;73(7):e98-e107. doi: 10.1093/geronb/gbx138.

Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines.

Author information

1
Wiser Healthcare, Sydney School of Public Health, The University of Sydney, New South Wales, Australia.
2
Centre for Medical Psychology and Evidence-based Decision-making (CeMPED), The University of Sydney, New South Wales, Australia.
3
Sydney Health Ethics, The University of Sydney, New South Wales, Australia.
4
Centre for Education and Research on Ageing (CERA), Ageing and Alzheimer's Institute, Concord Hospital, The University of Sydney, New South Wales, Australia.
5
Faculty of Pharmacy, The University of Sydney, New South Wales, Australia.

Abstract

Objectives:

Polypharmacy in the older population is increasing-and can be harmful. It can be safe to reduce or carefully cease medicines (deprescribing) but a collaborative approach between patient and doctor is required. This study explores decision-making about polypharmacy with older adults and their companions.

Method:

Semi-structured interviews were conducted with 30 older people (aged 75+ years, taking multiple medicines) and 15 companions. Framework analysis was used to identify qualitative themes.

Results:

Participants varied considerably in attitudes towards medicines, preferences for involvement in decision-making, and openness to deprescribing. Three types were identified. Type 1 held positive attitudes towards medicines, and preferred to leave decisions to their doctor. Type 2 voiced ambivalent attitudes towards medicines, preferred a proactive role, and were open to deprescribing. Type 3 were frail, perceived they lacked knowledge about medicines, and deferred most decisions to their doctor or companion.

Discussion:

This study provides a novel typology to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing. To enable shared decision-making, prescribers need to adapt their communication about polypharmacy based on their patients' attitudes to medicines and preferences for involvement in decisions.

PMID:
29190369
DOI:
10.1093/geronb/gbx138

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