Article Figures & Data
Figures
- Figure 1.
Patient Typology Based on Attitudes Toward Medication, Willingness to Deprescribe, and Proactiveness to Initiate a Conversation About Deprescribing
Note: Number of prescriptions is the mean (SD) number per patient.
a All proactive patients had a negative medication valuation and an openness to deprescribing.
Tables
Characteristic Value Age group, No. 65-74 years 5 75-84 years 9 ≥85 years 6 Sex, No. Female 11 Male 9 Morbidity, No. Independent or requiring a walking aid 19 Requiring a wheelchair 1 Number of regular medications, mean (SD) 7.9 (2.7) Number of PIMs,a mean (SD) 1.0 (0.8) PIM = potentially inappropriate medication.
↵a PIMs were defined as any drug name listed in Table 2 of the American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults.13
Category Theme (type) Subthemes and related quotes (patient and quote identifier) Medication valuation Negative valuation of a medication (enabler) Perceived burden of polypharmacy
My mother had Parkinson’s disease, and she took more than 10 different medicines a day. I thought, “If she takes this many pills, no wonder she has no appetite,” and I don’t want to take so many pills. (6-10)
Fear that medication may cause harm
I am still concerned about the increasing number of medications. I wonder if it will affect my liver. (15-9)
Lack of perceived benefits
I’m a little unclear on whether this medicine is working, and I’ve never broken bones before, so I thought, well, I don’t have to take it. (3-5)
Experience of successful deprescribing
I never felt worse when the doctor reduced my meds, and I felt good because nothing changed. (9-10)Positive perspective on medication (barrier) Acceptance of current situation through trust in prescriber
When the doctor says, “This is important (medicine),” I’m taking it because I have no choice, even though I want to stop taking it. He knows better than me. (6-7)
High expectations for medications
My blood pressure got better after I started taking the new medicine. I realized how important it is to take medicines. (13-3)Decision-making preference Proactive decision-making involvement preference (enabler) Preference for patient-centered decision making about medicines
It’s really important for me to know my condition well. Then the conversation (with the doctor) would naturally go in the direction of what drugs to use to improve my condition. (10-17)
Motivation for disease control through lifestyle modification
I can’t help it, it’s fate that I get sick, but I have to make some effort on my own. I think I can manage my high blood pressure and cholesterol a little more on my own. (8-2)Passive patient involvement and perceived lack of capability (barrier) Preference of deferring decision to prescriber
I believe I should leave my health and medications to my doctor. I take the medicines I receive as a matter of course, morning, noon, and night, and before going to bed. (1-10)
Difficulty in expressing opinions due to reticence toward the physician
There are times when I wonder if I really need these medicines. But as a patient, I am a little hesitant to ask the doctor to reduce the pills. I think everyone feels that way. (18-11)
Perceived lack of capability to deprescribe
I am sure that with my age, I will no longer be able to cope on my own. I would like to leave it to the doctor to take care of my health problems. (13-7)Openness to deprescribing Open to deprescribing proposal based on trust in prescriber (enabler) Trust in prescriber
I talk a lot during the examination, but she answers my questions without making me feel uncomfortable. That’s why I look forward to coming here. (7-9)
Openness to deprescribing if suggested by prescriber
If the doctor says it’s okay to reduce the pill(s), then I will accept it. I would feel safer if I had his approval. (19-4)Caution due to fear of change or satisfaction with the status quo (barrier) Fear of changing current medications
This medicine cures my stomach heaviness. I’m afraid to stop taking this because I think it helps me live without symptoms. (9-8)
Satisfaction with the status quo
The doctor examines and gives me medicines that best suit me, so taking them is the safest way. I’m already 80, and my job is to go to the hospital and take the pills. (7-2)
SUPPLEMENTAL MATERIALS IN PDF FILE BELOW
- ie_supp_app_T1_2.pdf -
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- ie_supp_app_T1_2.pdf -
VISUAL ABSTRACT IN PDF BELOW
- IE_VA.pdf -
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- IE_VA.pdf -
PLAIN-LANGUAGE SUMMARY
Original Research
Medication Attitudes, Decision Involvement, and Trust Shape Older Adults’ Willingness to Cut Back Prescriptions
Background and Goal:Polypharmacy, defined as taking 5 or more daily medications, raises the risk of adverse drug interactions and other health problems. Deprescribing means stopping or reducing drugs that no longer help or may cause harm. This study explored older adults’ perspectives on proactive deprescribing, identified barriers and enablers, and developed a typology of patient attitudes to inform patient-centered deprescribing interventions.
Study Approach:In this qualitative study, researchers conducted semistructured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more oral medications.
Main Results:
Enablers
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Negative valuation of medication: patients noted pill burden, possible harm, and past success in stopping drugs.
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Proactive decision making preference: a few patients wanted an active role and even started deprescribing talks.
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Openness based on trust in the prescriber: many said they would cut back if a trusted clinician suggested it.
Barriers
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Positive perspective on medication: satisfaction with current drugs or high expectations kept regimens unchanged.
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Passive involvement and low perceived capability: patients deferred to doctors and felt unable to ask about deprescribing.
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Caution driven by fear of change or comfort with the status quo: worry about symptom return discouraged stopping pills.
The researchers also developed a new typology with five types of patients: indifferent, satisfied and risk-averse, compliant, fearful but passive, and proactive.
Why it Matters:The findings from this study show that patients vary in their readiness to cut back on medications and underscore the importance of tailoring deprescribing discussions to each patient’s type and level of proactiveness.
Proactive Deprescribing Among Older Adults With Polypharmacy: Barriers and Enablers
Kenya Ie, MD, MPH, PhD, et al
Department of General Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Kanagawa, Japan
Visual Abstract
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