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

doi:10.3399/bjgp16X685669

Article Figures & Data

Tables

View popup

Table 1.

Eligibility criteria and participant characteristics

	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 Disadvantage^a (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.