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Research

Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study

Emily Reeve, Lee-Fay Low and Sarah N Hilmer
British Journal of General Practice 2016; 66 (649): e552-e560. DOI: https://doi.org/10.3399/bjgp16X685669
Emily Reeve
Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Northern Clinical School;
Roles: Postdoctoral research associate
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Lee-Fay Low
Associate professor in ageing and health, Faculty of Health Sciences, University of Sydney, Sydney.
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Sarah N Hilmer
Departments of Aged Care and Clinical Pharmacology, Royal North Shore Hospital, St Leonards, Sydney.
Roles: Professor of geriatric pharmacology
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    Table 1.

    Eligibility criteria and participant characteristics

    Carers (focus group 1), n = 8Carers (focus group 4), n = 6Older adults (focus group 2), n = 11Older adults (focus group 3), n = 3
    Residence (of participant or participant’s care recipient)CommunityResidential aged care facilityCommunityRetirement village
    Eligibility criteria
    • currently a non-paid carer for an older adult (aged >65 years) with ≥1 chronic medical conditions

    • care recipient must be taking

    • ≥1 regular prescription medications

    • conversationally proficient in English

    • aged >65 years

    • taking ≥1 regular prescription medication have ≥1 chronic medical conditions

    • conversationally proficient in English

    Age, years (mean ± SD)70.3 ± 8.379.0 ± 6.379.4 ± 6.079.0 ± 1.0
    Age of care recipient, years (mean ± SD)89.1 ± 11.585.2 ± 5.7
    Number of medications of self or care recipient, (mean ± SD)7.0 ± 5.23.4 ± 1.53.4 ± 2.05.3 ± 4.0
    Sex, (n female/n male)5/36/04/72/1
    Comorbidities, % (n) of self or care recipient
      Cardiovascular disease75 (6)67 (4)45 (5)33 (1)
      Gastrointestinal disease13 (1)0 (0)9 (1)33 (1)
      Diabetes50 (4)33 (2)0 (0)0 (0)
      Kidney disease13 (1)0 (0)0 (0)0 (0)
      Respiratory disease0 (0)17 (1)9 (1)0 (0)
      Arthritis38 (3)17 (1)27 (3)67 (2)
      Osteoporosis50 (4)0 (0)0 (0)67 (2)
      Memory problems75 (6)100 (6)27 (3)0 (0)
    Relationship of carer to care recipient, % (n)
      Spouse25 (2)83 (5)––
      Son/daughter38 (3)0 (0)––
      Other relative38 (3)0 (0)––
      Other non-relative0 (0)17 (1)––
      Local Health District Index of Relative Socioeconomic Disadvantagea (area where focus group was held)261104.81120.71104.8951
    • ↵a Australian scores are the reference point and are set to 1000 for each index (standard deviation of 100). Scores for local government areas are population-weighted means of the scores of their constituent census collector districts.

    • Centre for Epidemiology and Evidence.

  • GPs are the main driver for deprescribing because of their large influence not only on prescribing but also on patient perceptions and decisions about their health care
    • GPs need to be aware of their influence and not have fear of patient resistance.

    • More support needs to be provided to GPs to enable deprescribing in general practice (there are many barriers including lack of time and lack of guidelines).

    A process is required for deprescribing
    • A discussion needs to occur between healthcare professional and patient/carer.

    • Why the medication is being recommended for stopping needs to be explained including whether there is any ongoing benefit, what the long-term harms are, and why the medication is no longer appropriate in the current context of care.

    • Patients and carers are open to being involved in monitoring and expect to be informed by the healthcare professional what to monitor for and what to do if there is a change in condition.

    • It should be emphasised that medication withdrawal is on a trial basis.

    Where there is patient/carer resistance to discontinuation
    • Further discussion may reveal why they are hesitant (for example, previous experience).

    • Shared decision making is required to achieve a favourable outcome and maintain the doctor–patient relationship.

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British Journal of General Practice: 66 (649)
British Journal of General Practice
Vol. 66, Issue 649
August 2016
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Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study
Emily Reeve, Lee-Fay Low, Sarah N Hilmer
British Journal of General Practice 2016; 66 (649): e552-e560. DOI: 10.3399/bjgp16X685669

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Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study
Emily Reeve, Lee-Fay Low, Sarah N Hilmer
British Journal of General Practice 2016; 66 (649): e552-e560. DOI: 10.3399/bjgp16X685669
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Keywords

  • aged
  • caregivers
  • decision making
  • general practice
  • inappropriate prescribing
  • medication therapy management
  • primary health care

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