Abstract
Background
Deprescribing of preventive medications may be considered in some nursing home residents. It is important to understand how to effectively communicate around this complex decision, from both a physician and resident perspective.
Objective
The objective of this study was to explore how nursing home residents would like to discuss deprescribing of preventive medications with their physicians.
Methods
We conducted a qualitative study with face-to-face, semi-structured interviews. Participants were Danish nursing home residents aged ≥70 years deemed cognitively able to participate by nursing staff. They were taking one or more of statins, antihypertensives, antihyperglycemics, or antiplatelets. Interviews were audio recorded and transcribed verbatim. Analysis was conducted based on systematic text condensation.
Results
Nine nursing home residents (median age 85 years, seven female) were interviewed. Participants were generally aware of their overall number of medications but unaware of specific medications and why they were taking them. All participants displayed a high degree of trust in their physicians, preferring to defer decisions to them, and generally believed their medication was necessary if their physician had prescribed it. Residents would be open to deprescribing if their physician suggested it but were not aware of the possibility to be involved in the decision (e.g., discuss goals of care and treatment preferences) and had difficulty imagining what they could discuss with their physician about a deprescribing decision.
Conclusion
The interviewed nursing home residents could not imagine how they might discuss potential deprescribing of preventive medications with their physician, and what topics would be important. Future work should explore how nursing home residents can be encouraged to be part of such discussions and investigate ways to have residents share their goals and preferences regarding deprescribing.
References
Elseviers MM, Vander Stichele RR, Van Bortel L. Drug utilization in Belgian nursing homes: impact of residents’ and institutional characteristics. Pharmacoepidemiol Drug Saf. 2010;19(10):1041–8.
Poudel A, Yates P, Rowett D, Nissen LM. Use of preventive medication in patients with limited life expectancy: a systematic review. J Pain Symptom Manag. 2017;53(6):1097–110. https://doi.org/10.1016/j.jpainsymman.2016.12.350.
Malek Makan A, van Hout H, Onder G, Finne-Soveri H, van der Roest H, van Marum R. Prevalence of preventive cardiovascular medication use in nursing home residents. Room for deprescribing? The SHELTER study. J Am Med Dir Assoc. 2017;18(12):1037–42. https://doi.org/10.1016/j.jamda.2017.06.022
van Middelaar T, van Charante EPM. Deprescribing preventive medication in older patients. Br J Gen Pract. 2018;68(675):456–7. https://doi.org/10.3399/bjgp18X698933.
Krishnaswami A, Steinman MA, Goyal P, Zullo AR, Anderson TS, Birtcher KK, et al. Deprescribing in older adults with cardiovascular disease. J Am Coll Cardiol. 2019;73(20):2584–95. https://doi.org/10.1016/j.jacc.2019.03.467.
Hawley CE, Roefaro J, Forman DE, Orkaby AR. Statins for primary prevention in those aged 70 years and older: a critical review of recent cholesterol guidelines. Drugs Aging. 2019;36:687–99. https://doi.org/10.1007/s40266-019-00673-w.
Jansen J, Naganathan V, Carter SM, McLachlan AJ, Nickel B, Irwig L, et al. Too much medicine in older people? Deprescribing through shared decision making. BMJ. 2016;353:i2893. https://doi.org/10.1136/bmj.i2893.
Qi K, Reeve E, Hilmer SN, Pearson SA, Matthews S, Gnjidic D. Older peoples attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia. Int J Clin Pharm. 2015;37(5):949–57.
Reeve E, Wolff JL, Skehan M, Bayliss EA, Hilmer SN, Boyd CM. Assessment of attitudes toward deprescribing in older medicare beneficiaries in the United States. JAMA Intern Med. 2018;178(12):1673. https://doi.org/10.1001/jamainternmed.2018.4720.
Palagyi A, Keay L, Harper J, Potter J, Lindley RI. Barricades and brickwalls—a qualitative study exploring perceptions of medication use and deprescribing in long-term care. BMC Geriatr. 2016;15(16):15.
Kalogianis MJ, Wimmer BC, Turner JP, Tan ECK, Emery T, Robson L, et al. Are residents of aged care facilities willing to have their medications deprescribed? Res Social Adm Pharm. 12(5):784–8.
Reilev M, Lundby C, Jensen J, Larsen SP, Hoffmann H, Pottegård A. Morbidity and mortality among older people admitted to nursing home. Age Ageing. 2019;49(1):67–73. https://doi.org/10.1093/ageing/afz136.
Reeve E, Low L-F, Shakib S, Hilmer SN. Development and validation of the revised patients’ attitudes towards deprescribing (rPATD) questionnaire: versions for older adults and caregivers. Drugs Aging. 2016;33(12):913–28.
Weir K, Nickel B, Naganathan V, Bonner C, McCaffery K, Carter SM, et al. Decision-making preferences and deprescribing: perspectives of older adults and companions about their medicines. J Gerontol B Psychol Sci Soc Sci. 2018;73(7):e98–107. https://doi.org/10.1093/geronb/gbx138.
Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics; 2017;17(1):1–10.
Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res. 2016;26(13):1753–60. https://doi.org/10.1177/1049732315617444.
Malterud K. Systematic text condensation: a strategy for qualitative analysis. Scand J Soc Med. 2012;40(8):795–805. https://doi.org/10.1177/1403494812465030.
Reeve E, Low L-F, Hilmer SN. Attitudes of older adults and caregivers in Australia toward deprescribing. J Am Geriatr Soc. 2019;67(6):1204–10. https://doi.org/10.1111/jgs.15804.
Sirois C, Ouellet N, Reeve E. Community-dwelling older people’s attitudes towards deprescribing in Canada. Res Soc Adm Pharm. 2017;13(4):864–70. https://doi.org/10.1016/j.sapharm.2016.08.006
Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27(10):1361–7. https://doi.org/10.1007/s11606-012-2077-6.
Politi MC, Dizon DS, Frosch DL, Kuzemchak MD, Stiggelbout AM. Importance of clarifying patients’ desired role in shared decision making to match their level of engagement with their preferences. BMJ. 20132;347(dec02 1):f7066–f7066. https://doi.org/10.1136/bmj.f7066
Mangin D, Risdon C, Lamarche L, Langevin J, Ali A, Parascandalo J, et al. “I think this medicine actually killed my wife”: patient and family perspectives on shared decision-making to optimize medications and safety. Ther Adv Drug Saf. 2019;10:204209861983879. https://doi.org/10.1177/2042098619838796.
Muscat DM, Shepherd HL, Hay L, Shivarev A, Patel B, McKinn S, et al. Discussions about evidence and preferences in real-life general practice consultations with older patients. Patient Educ Couns. 2019;102(5):879–87. https://doi.org/10.1016/j.pec.2018.12.
deprescrbing.org. Resources for patients and healthcare providers. https://deprescribing.org/resources/. Accessed 2 Jan 2020
Canadian Deprescribing Network. Patients and public. https://www.deprescribingnetwork.ca/patients-and-public. Accessed 2 Jan 2020
Thompson W, Farrell B, Welch V, Tugwell P, Way C, Richardson L, et al. Continuation or deprescribing of proton pump inhibitors: a consult patient decision aid. Can Pharm J (Ott). 2019;152(1):18–22. https://doi.org/10.1177/1715163518816719.
van Middelaar T, Ivens SD, van Peet PG, Poortvliet RKE, Richard E, Pols AJ, et al. Prescribing and deprescribing antihypertensive medication in older people by Dutch general practitioners: a qualitative study. BMJ Open. 2018;8(4):e020871. https://doi.org/10.1136/bmjopen-2017-020871.
van der Ploeg MA, Streit S, Achterberg WP, Beers E, Bohnen AM, Burman RA, et al. Patient characteristics and general practitioners’ advice to stop statins in oldest-old patients: a survey study across 30 countries. J Gen Intern Med. 2019;34:1751. https://doi.org/10.1007/s11606-018-4795-x.
Acknowledgements
The authors would like to acknowledge Anton Pottegård and Line Bjørnskov Pedersen for their contribution to conception and design of the study, and Jette Videbæk Le for comments on the manuscript draft.
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WT, ITJ, CL, DJ, PH, and JBN conceived and designed the study. ITJ, WT, and CL acquired data. ITJ, WT, and CL analyzed and interpreted data. WT, ITJ, CL, DJ, PH, and JBN drafted and critically revised the manuscript.
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Wade Thompson, Ida Theemann Jacobsen, Dorte Ejg Jarbøl, Peter Haastrup, Jesper Bo Nielsen, and Carina Lundby declare they have no conflicts of interest.
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This research did not receive any funding from agencies in the public, commercial, or not-for-profit sectors.
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Thompson, W., Jacobsen, I.T., Jarbøl, D.E. et al. Nursing Home Residents’ Thoughts on Discussing Deprescribing of Preventive Medications. Drugs Aging 37, 187–192 (2020). https://doi.org/10.1007/s40266-020-00746-1
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DOI: https://doi.org/10.1007/s40266-020-00746-1