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Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

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Abstract

Background Deprescribing is the process of medication withdrawal with the aims of reducing the harms of potentially inappropriate medication use and improving patient outcomes. Deprescribing of statins may be indicated for some older people, because the evidence for benefit in primary prevention of cardiovascular disease is limited and there is an increased risk of side effects in old age. Objective To determine older peoples’ attitudes and beliefs regarding medication use and their willingness to have regular medications, particularly statins, deprescribed. Setting An Australian acute-care hospital. Method A cross-sectional study of patients admitted to a teaching hospital in Sydney, Australia, aged ≥65 years and taking a statin was conducted. Attitudes and beliefs regarding medication use and willingness to have medications or statins deprescribed were captured using the validated Patients’ Attitudes Towards Deprescribing questionnaire, supplemented with additional statin-specific questions. Main outcome measures. Older inpatients’ attitudes and perspectives towards stopping medications, in particular statins. Results Overall, 180 participants were recruited, with a median age of 78 years, (interquartile range 71–85). Eighty-nine percent (95 % CI 84.4–93.6) of participants reported that they would be willing to stop one or more of their regular medications if their doctor said it was possible. Ninety-five percent (95 % CI 91.8–98.2) agreed that they would be willing to have a statin deprescribed. Moreover, 94 % (95 % CI 90.5–97.5) of participants expressed concern regarding the potential side effects of taking a statin. Conclusion The majority of older inpatients using statins are willing to have one or more of their current medications, including statins, deprescribed. These findings can be used to inform clinical practice and interventional statin deprescribing studies to optimise medication use in older adults.

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References

  1. Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust. 2014;201(7):390–2.

    Article  PubMed  Google Scholar 

  2. Gnjidic D, Le Couteur DG, Hilmer SN. Discontinuing drug treatments. BMJ. 2014;349:g7013.

    Article  PubMed  Google Scholar 

  3. Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. The benefits and harms of deprescribing. Med J Aust. 2014;201(7):386–9.

    Article  PubMed  Google Scholar 

  4. Le Couteur D, Banks E, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr. 2011;34(6):182–5.

  5. Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738–47.

    Article  PubMed Central  PubMed  Google Scholar 

  6. Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.

    Article  PubMed  Google Scholar 

  7. Beer C, Loh PK, Peng YG, Potter K, Millar A. A pilot randomized controlled trial of deprescribing. Ther Adv Drug Saf. 2011;2(2):37–43.

    Article  PubMed Central  PubMed  Google Scholar 

  8. Williams ME, Pulliam CC, Hunter R, Johnson TM, Owens JE, Kincaid J, et al. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004;52(1):93–8.

    Article  PubMed  Google Scholar 

  9. Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015;49(1):29–38.

    Article  PubMed  Google Scholar 

  10. Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of dutch gps. A qualitative study. BMC Fam Pract. 2012;13:56.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Dickinson R, Knapp P, House AO, Dimri V, Zermansky A, Petty D, et al. Long-term prescribing of antidepressants in the older population: a qualitative study. Br J Gen Pract. 2010;60(573):e144–55.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Mazor KM, Velten S, Andrade SE, Yood RA. Older women’s views about prescription osteoporosis medication: a cross-sectional, qualitative study. Drugs Aging. 2010;27(12):999–1008.

    Article  PubMed  Google Scholar 

  13. Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA. Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor–positive breast cancer. J Clin Oncol. 2004;22(16):3309–15.

    Article  PubMed  Google Scholar 

  14. Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99(2):215–20.

    Article  PubMed  Google Scholar 

  15. Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14.

    Article  PubMed  Google Scholar 

  16. Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.

    Article  PubMed  Google Scholar 

  17. Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician. 2012;41(12):924–8.

    PubMed  Google Scholar 

  18. Roberts CG, Guallar E, Rodriguez A. Efficacy and safety of statin monotherapy in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62(8):879–87.

    Article  PubMed  Google Scholar 

  19. Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;1:Cd004816.

    PubMed  Google Scholar 

  20. Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ. 2013;347:f6123.

    Article  PubMed  Google Scholar 

  21. Berthold HK, Gouni-Berthold I. Lipid-lowering drug therapy in elderly patients. Curr Pharm Des. 2011;17(9):877–93.

    Article  CAS  PubMed  Google Scholar 

  22. Savarese G, Gotto AM Jr, Paolillo S, D’Amore C, Losco T, Musella F, et al. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2013;62(22):2090–9.

    Article  CAS  PubMed  Google Scholar 

  23. Szadkowska I, Stanczyk A, Aronow WS, Kowalski J, Pawlicki L, Ahmed A, et al. Statin therapy in the elderly: a review. Arch Gerontol Geriatr. 2010;50(1):114–8.

    Article  CAS  PubMed  Google Scholar 

  24. Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Development and validation of the patients’ attitudes towards deprescribing (patd) questionnaire. Int J Clin Pharm. 2013;35(1):51–6.

    Article  PubMed  Google Scholar 

  25. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.

    Article  CAS  PubMed  Google Scholar 

  26. Folstein MF, Folstein SE, McHugh PR. ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.

    Article  CAS  PubMed  Google Scholar 

  27. Hilmer SN, Perera V, Mitchell S, Murnion BP, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.

    Article  PubMed  Google Scholar 

  28. Gnjidic D, Le Couteur DG, Blyth FM, Travison T, Rogers K, Naganathan V, et al. Statin use and clinical outcomes in older men: A prospective population-based study. BMJ Open. 2013;3(3):e002333.

  29. Perreault S, Blais L, Dragomir A, Bouchard MH, Lalonde L, Laurier C, et al. Persistence and determinants of statin therapy among middle-aged patients free of cardiovascular disease. Eur J Clin Pharmacol. 2005;61(9):667–74.

    Article  PubMed  Google Scholar 

  30. van Duijn HJ, Belo JN, Blom JW, Velberg ID, Assendelft WJ. Revised guidelines for cardiovascular risk management time to stop medication? A practice-based intervention study. Br J Gen Pract. 2011;61(587):e347–52.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Modig S, Kristensson J. Kristensson Ekwall A, Rahm Hallberg I, Midlöv P. Frail elderly patients in primary care—their medication knowledge and beliefs about prescribed medicines. Eur J Clin Pharmacol. 2009;65(2):151–5.

    Article  PubMed  Google Scholar 

  32. Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding statin use in america and gaps in patient education (usage): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6(3):208–15.

    Article  PubMed  Google Scholar 

  33. Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311–6.

    Article  PubMed  Google Scholar 

  34. Reaume KT, Erickson SR, Dorsch MP, Dunham NL, Hiniker SM, Prabhakar N, et al. Effects of cerivastatin withdrawal on statin persistence. Ann Pharmacother. 2008;42(7):956–61.

    Article  PubMed  Google Scholar 

  35. Stack RJ, Elliott RA, Noyce PR, Bundy C. A qualitative exploration of multiple medicines beliefs in co-morbid diabetes and cardiovascular disease. Diabet Med. 2008;25(10):1204–10.

    Article  CAS  PubMed  Google Scholar 

  36. Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Bernal DDL, Bereznicki LRE, Peterson GM. With great power comes great responsibility. Med J Aust. 2014;200(5):321.

    Article  PubMed  Google Scholar 

  38. Kon RH, Russo MW, Ory B, Mendys P, Simpson RJ Jr. Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising. J Clin Lipidol. 2008;2(1):51–7.

    Article  PubMed  Google Scholar 

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Acknowledgments

The authors would like to acknowledge Ms Michele Thai who contributed to the data collection.

Funding

The authors received no sponsorship or funding for this study. Danijela Gnjidic is supported by the Australian National Health and Medical Research Early Career Fellowship. Sallie Pearson is a Cancer Institute NSW Career Development Fellow.

Conflicts of interest

The authors have no conflicts of interest to declare.

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    Authors and Affiliations

    1. Faculty of Pharmacy, University of Sydney, Sydney, NSW, Australia

      Katie Qi, Sallie-Anne Pearson & Danijela Gnjidic

    2. Sydney Medical School, University of Sydney, Sydney, NSW, Australia

      Emily Reeve, Sarah N. Hilmer, Slade Matthews & Danijela Gnjidic

    3. Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia

      Emily Reeve & Sarah N. Hilmer

    4. Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia

      Sallie-Anne Pearson

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    1. Katie Qi
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    2. Emily Reeve
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    6. Danijela Gnjidic
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    Correspondence to Emily Reeve.

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    Katie Qi and Emily Reeve have contributed equally to this article.

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    Qi, K., Reeve, E., Hilmer, S.N. et al. Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm 37, 949–957 (2015). https://doi.org/10.1007/s11096-015-0147-7

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    • DOI: https://doi.org/10.1007/s11096-015-0147-7

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