Study explores older adults' perspectives on proactive deprescribing

Background and goal: This study explored older adults' perspectives on proactive deprescribing, identified barriers and enablers, and developed a typology of patient attitudes to inform patient-centered deprescribing interventions.

Study approach: In this qualitative study, researchers conducted semi structured interviews with 20 patients in Japan aged 65 years or older who were receiving 5 or more oral medications. 

Main results:

Enablers

• Negative valuation of medication: patients noted pill burden, possible harm and past success in stopping drugs.

• Proactive decision making preference: a few patients 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.

Barriers

• Positive perspective on medication: satisfaction with current drugs or high expectations kept regimens unchanged.

• Passive involvement and low perceived capability: patients 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 also developed a new typology with five types of patients: indifferent, satisfied and risk-averse, compliant, fearful but passive, and proactive.

Why it matters: The findings from this study show that patients vary in their readiness to cut back on medications and underscore the importance of tailoring deprescribing discussions to each patient.