Barriers and enablers of older adults initiating a deprescribing conversation. Issue 3 (March 2022)

• Record Type: Journal Article
• Authors: Ailabouni, Nagham J.; Rebecca Weir, Kristie; Reeve, Emily; Turner, Justin T.; Wilson Norton, Jennifer; Gray, Shelly L.
• Is Part Of: Patient education and counseling. Volume 105:Issue 3(2022)
• Page Start: 615
• Page End: 624
• Publication Date: 2022-03
• Subjects: Deprescribing -- Deprescription -- Inappropriate prescribing -- Aged 80 and over -- Barriers -- Enablers -- Shared decision-making; Patient education -- Periodicals; Health counseling -- Periodicals; Health education -- Periodicals; Counseling -- Periodicals; Patient Education -- Periodicals; Éducation des patients -- Périodiques; Counseling -- Périodiques; Éducation sanitaire -- Périodiques; 615.5071
• DOI: 10.1016/j.pec.2021.06.021
• Languages: English
• ISSNs: 0738-3991

Abstract

Highlights: Patient empowerment has been shown to be a successful deprescribing strategy. Empowering older adults to initiate a deprescribing conversation remains limited. Barriers prevent older adults from initiating a deprescribing conversation. Strategies to promote self-efficacy amongst older adults are needed. Abstract: Objective: To examine older adults' perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider. Methods: We conducted one focus group (n = 3) and in-depth, face-to-face, individual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted. Results: Five themes and fourteen sub-themes were identified. Theme 1, 'older adult-related barriers', discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, 'provider-related barriers', discusses trust, short office visits, lack of communication and multiple providers. Theme 3, 'environmental/social-related barriers', involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4–5) identified enablers including strategies to promote older adults' self-efficacy and improved healthcare communication. Conclusion: Consumer-centric tools could improve older adults' self-efficacy to initiate deprescribing conversations. Practice Implications: Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.