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The three ways older adults approach deprescribing: study

A tailored approach to deprescribing less effective medicines will get the best results among older adults, a team of University of Sydney researchers say.

Lead researcher Kristie Weir said it can be safe to reduce or carefully cease medicines but a collaborative approach between patient and doctor is needed. “Deprescribing isn’t new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients,” Weir said.

She said considering the variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.

The team categorised three distinct types of people and said this could help guide the type of advice given by clinicians to older people when discussing the issues around taking multiple medicines. Weir said: “Recognising these three types of patients can help clinicians tailor their communication approaches.”

Type one:

People who are resistant to deprescribing and are very attached to their medications as they are perceived as highly important to their wellbeing. This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.

Type two:

These people indicated they were open to deprescribing and preferred an active role in decision-making to share responsibility with their doctor. They would consider deprescribing and said they didn’t like the idea of completely relying on medications to stay healthy. This group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:

People who were less engaged in decision-making, most deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn’t give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.

Weir said the research, published today in the Journal of Gerontology, shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care.

“For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.

“We need to develop ways to support clinicians and patients to have these important but challenging conversations,” she says.

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