Community-dwelling older people's attitudes towards deprescribing in Canada
Introduction
Medication use has been steadily increasing over time. In Canada, it represents the third-largest portion of healthcare expenses.1 Polypharmacy is frequent, especially for older individuals. In 2012, two thirds of Canadians 65 years and over used at least 5 unique prescription medications, and nearly a third used more than 10.2 However, polypharmacy has been associated with hospitalization, deaths, falls, functional impairment,3 increased risk of drug interactions4 and use of inappropriate medications.5 It thus appears fundamental to tackle the risks polypharmacy imposes. Deprescribing methods – the systematic processes of withdrawal of inappropriate medications in an individual in order to reduce polypharmacy and eventually improve health outcomes-appear promising to reach this aim.6
In accordance with patient-centered care and shared decision-making, deprescribing involves an implicit partnership between the health providers and the individuals. The individuals' commitment in the process, and thereby its success, is likely to be influenced by the perception they have of their medications and deprescribing. A small number of previous studies have explored this using the Patients' Attitudes Towards Deprescribing questionnaire.7 Three studies have been conducted in Australia (in outpatients attending an ambulatory hospital consulting service,8 hospital inpatient statin users9 and residential aged care facilities residents10) and one in Italian hospital inpatients.11 These studies found that between 80 and 92% of participants reported being willing to have one or more of their medications deprescribed if their doctor said it was possible. However, the perspectives that older individuals living in the community hold about deprescribing remains largely unknown. We therefore aimed to describe the community-dwelling older individuals' attitudes and perceptions towards deprescribing in the province of Quebec, Canada.
Section snippets
Survey
A survey was created that was adapted from the Patients' Attitudes Towards Deprescribing questionnaire.7 The participants had to rate their agreement on a 5-point, Likert-type scale on 10 questions and answer 5 multiple-choice questions about polypharmacy and deprescribing. They were also asked to report their age, sex, number of medications taken, use of pill-dispensing aids, and who manages medications.
Study population and recruitment
The surveys were distributed in 10 community pharmacies and 2 community centers located
Results
A total of 138 individuals responded to the survey. We excluded 9 individuals because they were less than 65 years. Table 1 presents the characteristics of the 129 individuals included. Most of the participants were women (81 individuals, 63%) and the median age was 76 years (IQR:71–80). They were taking a median number of daily medications of 6 (IQR: 3–8), and the vast majority (114 individuals, 88%) self-managed their medications.
Table 2 reports the participants' responses to the first ten
Discussion
Around half of the older Quebeckers living in the community indicated they would like to reduce the number of medications they are taking. Nearly three out of four participants would be willing to have a medication deprescribed if their doctor said it was possible. The perception that they were taking a large number of medications, that they were experiencing a side effect, and that one or more of their medications is no longer necessary were some of the most important beliefs associated with
Conclusion
The need to prevent unnecessary polypharmacy is growing, as there are rising concerns about the vertiginous escalation in the number of medications older individuals are exposed to. The results of this study show that older individuals in the community are eager to undertake deprescribing, especially if they have a large number of medications, are experiencing side effects or feel some medications are no longer necessary. There is a need to demystify deprescribing and empower older adults to
Acknowledgments
We are grateful to all the participants, the pharmacists and the community centres supervisors who were involved in the study. We particularly thank Isabelle Lebrasseur and Lydia Huard who have been explaining the survey and helping older individuals in community pharmacies and community centers to answer it. We also thank Marie-Eve Gagnon and Joannie Renaud, who recruited pharmacists and imported data in SPSS. Finally, we thank the pharmacy students who played diverse roles in the study
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Conflict of interest: The authors report no conflict of interest.