Researchers in Japan explored older adults’ perspectives on proactive deprescribing of unneeded medications, identified enablers and barriers, and developed a typology of patient attitudes to inform patient-centered deprescribing interventions. They did this by conducting interviews with 20 patients in Japan ages 65 years or older who were receiving five or more oral medications.

Overall, individuals’ attitudes toward deprescribing varied considerably according to their medication valuation, preference for involvement in decision making, and openness to deprescribing. Placing a low value on medication was an important trigger of  proactive attitudes toward deprescribing. People also were open to deprescribing conversations if they trusted the prescriber.

Conversely, people who had a positive perspective on medication or considered themselves incapable of participating in decision making preferred to defer to a physician.

The main enablers of deprescribing included:

• Negative valuation of medication: people noted pill burden, possible harm and past success in stopping drugs.
• Proactive decision-making preference: a few individuals wanted an active role and even started deprescribing talks.
• Openness based on trust in the prescriber: many said they would cut back if a trusted clinician suggested it.

The main barriers were:

• Positive perspective on medication: satisfaction with current drugs or high expectations kept regimens unchanged.
• Passive involvement and low perceived capability: people deferred to doctors and felt unable to ask about deprescribing.
• Caution driven by fear of change or comfort with the status quo; worry about symptom return discouraged stopping pills.

The researchers' new typology included five types of individuals: indifferent (15% of participants), satisfied and risk-averse (10%), compliant (30%), fearful but passive (20%), and proactive (25%).

To download the article, published in Annals of Family Medicine, click here