Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines. (28th November 2017)

• Record Type: Journal Article
• Authors: Weir, Kristie; Nickel, Brooke; Naganathan, Vasi; Bonner, Carissa; McCaffery, Kirsten; Carter, Stacy M; McLachlan, Andrew; Jansen, Jesse
• Is Part Of: Journals of gerontology. Volume 73:Number 7(2018)
• Page Start: e98
• Page End: e107
• Publication Date: 2017-11-28
• Subjects: Shared decision making -- Polypharmacy -- Communication; Geriatrics -- Periodicals; Gerontology -- Periodicals; Aged -- Periodicals; Aging -- Periodicals; Psychology, Social -- Periodicals; 305.26
• DOI: 10.1093/geronb/gbx138
• Languages: English
• ISSNs: 1079-5014

Abstract

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.