Objectives Older Australians, aged ≥65 commonly take ≥5 daily medications, generally described as polypharmacy. Whilst polypharmacy is often appropriate, it is associated with higher personal and health system costs related to adverse drug events, inappropriate medication use and poor health outcomes. Deprescribing or discontinuing low value or potentially harmful medications is one strategy to reduce polypharmacy. Earlier research of older adults’ attitudes to polypharmacy suggest mixed attitudes toward ongoing medication use, but a willingness to consider deprescribing if recommended by their doctor. This study further explored the relationship between attitudes to polypharmacy and willingness to consider deprescribing.
Methods A convenience sample of independent, community living older adults from regional NSW, Australia aged ≥65 years, taking ≥five medications, were invited to take part in individual one-on-one interviews between August 2017 and October 2018. A question guide was developed based on an earlier survey conducted in the same population group and a review of the literature. Preliminary analysis of an initial group of 12 interviews was conducted before further refining the question guide. Interviews were transcribed verbatim, coded and analysed thematically using NVivo 12.
Results Altogether, 25 participants were interviewed. The median age of the group was 79 (range 69–95) and they were taking a median of 10 medications (range 5–25). Attitudes to polypharmacy were found to be complex and many layered. Themes in the participants’ accounts indicated both acceptance and reluctance or ambiguity. Acceptance was shaped by their experience and values. They recalled experiences of family members who had poor health or died prematurely because they had not used medicines and the better health of theirs’ compared to previous generations because of the availability of medicines. They valued managing their health so as not to become a burden on others and desired to remain active, in relatively good health and avoid disability and premature death. Their trust in their doctors’ medical knowledge also influenced their sometimes unquestioning acceptance of polypharmacy. Concurrently, reluctance and ambiguity arose from concerns about the potential risks related to medication interactions, side effects and a general dislike of taking multiple medications and the inconvenience involved. Although older adults talked of a desire to take fewer medications, most took a pragmatic approach believing that this would not be a real option in their circumstances.
Conclusion Older adults using polypharmacy generally accept the need to do so. Preferences to continue medications may be based on influential life experiences, values and prescriber trust. These allow older adults to frame risks as acceptable compared to the overall value of ongoing polypharmacy use. Trust in their prescribers’ medical knowledge can become an obstacle to opportunities to deprescribe as some were less likely to question their medications. Older adult preferences driving deprescribing decisions are likely to be quite different from those that are being considered as important by their prescriber. However these preferences need to be explored alongside those of the prescriber in deprescribing discussions in order to provide patient centered care and facilitate shared decision-making.
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