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Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy

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Abstract

Background From 20 to 65 % of older adults receiving polypharmacy take at least one potentially inappropriate medication (PIM), leading to a high risk of adverse drug reactions. The term deprescribing was coined to describe a process of optimization of drug regimens through the withdrawal of PIMs. There is a paucity of evidence on the attitudes, beliefs and willingness of hospitalized patients towards deprescribing. Objective To measure at hospital discharge inpatients’ attitudes and beliefs towards polypharmacy and the potential withdrawal of one or more of their medications using the PATD (Patients’ Attitudes Towards Deprescribing) questionnaire and determine if they are associated with participant characteristics. Setting Geriatric and internal medicine wards in an Italian teaching hospital. Method Administration of the PATD questionnaire (developed and validated in an Australian outpatient setting, translated and adapted to the Italian setting for this study) to a consecutive sample of 100 older (aged ≥65 years) inpatients with polypharmacy who were interviewed by a nurse or pharmacist at the time of hospital discharge. Main outcome measure Older patients’ attitudes and beliefs towards reducing medications and participant characteristics. Results Eighty-nine percent of patients surveyed would like to reduce the number of daily medications. The desire for deprescribing was not associated with age, sex or number of medications or medical conditions; older patients were less aware of the reasons for taking medications. Conclusion The majority of hospitalized older adults with polypharmacy think they are taking a lot of drugs and would like to reduce this number. Older adults should not be considered a major limitation on deprescribing interventions. Future research should examine this issue with qualitative studies in order to gain a more in-depth understanding and explore how these findings can be translated into a multidisciplinary deprescribing process.

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Acknowledgments

The authors would like to acknowledge Vito Ladisa, Luca Pasina, Ilaria Speranza and Djignefa Djade Codjo for their contribution to the study development and data analysis.

Funding

None.

Conflicts of interest

The authors have no conflicts of interest to declare.

Author information

Authors and Affiliations

  1. Area Terapie Intensive - SITRA, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

    Alessandro Galazzi

  2. Department of Biomedical Sciences for Health, University of Milan, Via Pascal 36, 20133, Milan, Italy

    Maura Lusignani

  3. IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

    Maura Lusignani

  4. Clinical Pharmacology, IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, 20122, Milan, Italy

    Maria Teresa Chiarelli

  5. A. Bianchi Bonomi Hemophilia and Thrombosis Center, Piazza Castello 2, 20121, Milan, Italy

    Pier Mannuccio Mannucci

  6. Department of Neuroscience, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Via Giuseppe La Masa 19, 20156, Milan, Italy

    Carlotta Franchi, Mauro Tettamanti & Alessandro Nobili

  7. Cognitive Decline Partnership Centre, Kolling Institute of Medical Research, Royal North Shore Hospital, Pacific Hwy, St Leonards, NSW, 2065, Australia

    Emily Reeve

  8. IRCCS Fondazione Ca’ Granda Ospedale Maggiore Policlinico, Via Pace 9, 20122, Milan, Italy

    Pier Mannuccio Mannucci

  9. University of Sydney, Sydney, NSW, Australia

    Emily Reeve

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  1. Alessandro Galazzi
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  2. Maura Lusignani
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  3. Maria Teresa Chiarelli
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  4. Pier Mannuccio Mannucci
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  7. Emily Reeve
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  8. Alessandro Nobili
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Correspondence to Alessandro Galazzi.

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Galazzi, A., Lusignani, M., Chiarelli, M.T. et al. Attitudes towards polypharmacy and medication withdrawal among older inpatients in Italy. Int J Clin Pharm 38, 454–461 (2016). https://doi.org/10.1007/s11096-016-0279-4

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  • DOI: https://doi.org/10.1007/s11096-016-0279-4

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