Article Figures & Data
Tables
Carers (focus group 1), n = 8 Carers (focus group 4), n = 6 Older adults (focus group 2), n = 11 Older adults (focus group 3), n = 3 Residence (of participant or participant’s care recipient) Community Residential aged care facility Community Retirement 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 ± 8.3 79.0 ± 6.3 79.4 ± 6.0 79.0 ± 1.0 Age of care recipient, years (mean ± SD) 89.1 ± 11.5 85.2 ± 5.7 Number of medications of self or care recipient, (mean ± SD) 7.0 ± 5.2 3.4 ± 1.5 3.4 ± 2.0 5.3 ± 4.0 Sex, (n female/n male) 5/3 6/0 4/7 2/1 Comorbidities, % (n) of self or care recipient Cardiovascular disease 75 (6) 67 (4) 45 (5) 33 (1) Gastrointestinal disease 13 (1) 0 (0) 9 (1) 33 (1) Diabetes 50 (4) 33 (2) 0 (0) 0 (0) Kidney disease 13 (1) 0 (0) 0 (0) 0 (0) Respiratory disease 0 (0) 17 (1) 9 (1) 0 (0) Arthritis 38 (3) 17 (1) 27 (3) 67 (2) Osteoporosis 50 (4) 0 (0) 0 (0) 67 (2) Memory problems 75 (6) 100 (6) 27 (3) 0 (0) Relationship of carer to care recipient, % (n) Spouse 25 (2) 83 (5) – – Son/daughter 38 (3) 0 (0) – – Other relative 38 (3) 0 (0) – – Other non-relative 0 (0) 17 (1) – – Local Health District Index of Relative Socioeconomic Disadvantagea (area where focus group was held)26 1104.8 1120.7 1104.8 951 ↵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.