Association Between Willingness to Deprescribe and Health Outcome Priorities Among U.S. Older Adults: Results of a National Survey

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2022 Jun 6

PMID 35661991

Authors

Ariel R Green

Helene Aschmann

Cynthia M Boyd

Nancy Schoenborn

Affiliations

Soon will be listed here.

Abstract

Background: It is not known whether older adults' willingness to deprescribe is associated with their health outcome priorities related to medications.

Methods: A cross-sectional survey was conducted from March-April 2020 using a nationally representative online panel. The survey presented two vignettes: (1) a preventive medicine; and (2) a symptom-relief medicine. Participants were asked whether they would be willing to stop each medicine if their doctor recommended it, and to rate their level of agreement with two health outcome priorities statements: "I am willing to accept the risk of future side effects … to feel better now," and "I would prefer to take fewer medicines, even if … I may not live as long or may have bothersome symptoms sometimes." Ordinal logistic regression was used to examine associations between willingness to stop each medicine, baseline characteristics and health outcome priorities.

Results: Of 1193 panel members ≥65 years invited to participate, 835 (70%) completed the survey. Mean (SD) age was 73 years; 496 (59%) had taken a statin and 124 (15%) a prescription sedative-hypnotic. 507 (61%) were willing to stop preventive medicines; 276 (33%) were maybe willing. 419 (50%) were willing to stop symptom-relief medicines; 380 (46%) were maybe willing. Prioritizing fewer medicines was associated with higher odds of being willing to stop symptom-relief medicines (aOR 1.43 [95% CI 1.02-2.00]) and preventive medicines (aOR 1.52 [95% CI 1.05-2.18]). Prioritizing now over future was associated with lower odds of being willing to stop symptom-relief medicines (aOR 0.62 [95% CI 0.39-1.00]). Current/prior use of statins was associated with lower willingness to stop preventive medicines (aOR 0.66 [95% CI 0.48-0.91]).

Conclusions: Older adults' health outcome priorities related to medication use are associated with their willingness to consider deprescribing. Future research should determine how best to elicit patients' health outcome priorities to facilitate goal-concordant decisions about medication use.

Citing Articles

Older Adults' Attitudes Toward Deprescribing in 14 Countries.

Vidonscky Luthold R, Jungo K, Weir K, Adler L, Asenova R, Ares-Blanco S JAMA Netw Open. 2025; 8(2):e2457498.

PMID: 39928337 PMC: 11811803. DOI: 10.1001/jamanetworkopen.2024.57498.

Willingness to take less medication for type 2 diabetes among older patients: The Diabetes & Aging Study.

Haider S, Parker M, Huang E, Grant R, Moffet H, Laiteerapong N J Am Geriatr Soc. 2024; 72(7):1985-1994.

PMID: 38471959 PMC: 11226366. DOI: 10.1111/jgs.18870.

Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation.

Weir K, Shang J, Choi J, Rana R, Vordenberg S JAMA Netw Open. 2023; 6(10):e2337281.

PMID: 37819657 PMC: 10568363. DOI: 10.1001/jamanetworkopen.2023.37281.

Ethical Aspects of Physician Decision-Making for Deprescribing Among Older Adults With Dementia.

Norton J, Zeng C, Bayliss E, Shetterly S, Williams N, Reeve E JAMA Netw Open. 2023; 6(10):e2336728.

PMID: 37787993 PMC: 10548310. DOI: 10.1001/jamanetworkopen.2023.36728.

Association between willingness to deprescribe and health outcome priorities among U.S. older adults: Results of a national survey.

Green A, Aschmann H, Boyd C, Schoenborn N J Am Geriatr Soc. 2022; 70(10):2895-2904.

PMID: 35661991 PMC: 9588518. DOI: 10.1111/jgs.17917.

References

Roughead E, Anderson B, Gilbert A . Potentially inappropriate prescribing among Australian veterans and war widows/widowers. Intern Med J. 2007; 37(6):402-5. DOI: 10.1111/j.1445-5994.2007.01316.x. View

Toto P, Skidmore E, Terhorst L, Rosen J, Weiner D . Goal Attainment Scaling (GAS) in geriatric primary care: a feasibility study. Arch Gerontol Geriatr. 2014; 60(1):16-21. DOI: 10.1016/j.archger.2014.10.022. View

Moorhouse P, Theou O, Fay S, McMillan M, Moffatt H, Rockwood K . Treatment in a Geriatric Day Hospital improve individualized outcome measures using Goal Attainment Scaling. BMC Geriatr. 2017; 17(1):9. PMC: 5219800. DOI: 10.1186/s12877-016-0397-9. View

Yebyo H, Aschmann H, Menges D, Boyd C, Puhan M . Net benefit of statins for primary prevention of cardiovascular disease in people 75 years or older: a benefit-harm balance modeling study. Ther Adv Chronic Dis. 2019; 10:2040622319877745. PMC: 6764041. DOI: 10.1177/2040622319877745. View

Tinetti M, McAvay G, Fried T, Allore H, Salmon J, Foody J . Health outcome priorities among competing cardiovascular, fall injury, and medication-related symptom outcomes. J Am Geriatr Soc. 2008; 56(8):1409-16. PMC: 3494099. DOI: 10.1111/j.1532-5415.2008.01815.x. View

Verdoorn S, van de Pol J, Hovels A, Kwint H, Blom J, Gussekloo J . Cost-utility and cost-effectiveness analysis of a clinical medication review focused on personal goals in older persons with polypharmacy compared to usual care: Economic evaluation of the DREAMeR study. Br J Clin Pharmacol. 2020; 87(2):588-597. DOI: 10.1111/bcp.14421. View

Green A, Segal J, Boyd C, Huang J, Roth D . Patterns of Potentially Inappropriate Bladder Antimuscarinic Use in People with Dementia: A Retrospective Cohort Study. Drugs Real World Outcomes. 2020; 7(2):151-159. PMC: 7221072. DOI: 10.1007/s40801-020-00181-z. View

Verdoorn S, Kwint H, Blom J, Gussekloo J, Bouvy M . DREAMeR: Drug use Reconsidered in the Elderly using goal Attainment scales during Medication Review; study protocol of a randomised controlled trial. BMC Geriatr. 2018; 18(1):190. PMC: 6109293. DOI: 10.1186/s12877-018-0877-1. View

Schuling J, Gebben H, Veehof L, Haaijer-Ruskamp F . Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract. 2012; 13:56. PMC: 3391990. DOI: 10.1186/1471-2296-13-56. View

10.

Fried T, Street Jr R, Cohen A . Chronic Disease Decision Making and "What Matters Most". J Am Geriatr Soc. 2020; 68(3):474-477. PMC: 7197748. DOI: 10.1111/jgs.16371. View

11.

Kerns J, Winter J, Winter K, Kerns C, Etz R . Caregiver Perspectives About Using Antipsychotics and Other Medications for Symptoms of Dementia. Gerontologist. 2017; 58(2):e35-e45. DOI: 10.1093/geront/gnx042. View

12.

Kalisch L, Caughey G, Barratt J, Ramsay E, Killer G, Gilbert A . Prevalence of preventable medication-related hospitalizations in Australia: an opportunity to reduce harm. Int J Qual Health Care. 2012; 24(3):239-49. DOI: 10.1093/intqhc/mzs015. View

13.

Reeve E, Wiese M, Hendrix I, Roberts M, Shakib S . People's attitudes, beliefs, and experiences regarding polypharmacy and willingness to Deprescribe. J Am Geriatr Soc. 2013; 61(9):1508-14. DOI: 10.1111/jgs.12418. View

14.

Goodman C, Brett A . A Clinical Overview of Off-label Use of Gabapentinoid Drugs. JAMA Intern Med. 2019; 179(5):695-701. DOI: 10.1001/jamainternmed.2019.0086. View

15.

Green A, Aschmann H, Boyd C, Schoenborn N . Assessment of Patient-Preferred Language to Achieve Goal-Aligned Deprescribing in Older Adults. JAMA Netw Open. 2021; 4(4):e212633. PMC: 8022217. DOI: 10.1001/jamanetworkopen.2021.2633. View

16.

Sepucha K, Borkhoff C, Lally J, Levin C, Matlock D, Jenn Ng C . Establishing the effectiveness of patient decision aids: key constructs and measurement instruments. BMC Med Inform Decis Mak. 2014; 13 Suppl 2:S12. PMC: 4044563. DOI: 10.1186/1472-6947-13-S2-S12. View

17.

Fried T, Tinetti M, Iannone L, OLeary J, Towle V, Van Ness P . Health outcome prioritization as a tool for decision making among older persons with multiple chronic conditions. Arch Intern Med. 2011; 171(20):1854-6. PMC: 4036681. DOI: 10.1001/archinternmed.2011.424. View

18.

Case S, OLeary J, Kim N, Tinetti M, Fried T . Older Adults' Recognition of Trade-Offs in Healthcare Decision-Making. J Am Geriatr Soc. 2015; 63(8):1658-62. PMC: 4892363. DOI: 10.1111/jgs.13534. View

19.

Reeve E, Wolff J, Skehan M, Bayliss E, Hilmer S, Boyd C . Assessment of Attitudes Toward Deprescribing in Older Medicare Beneficiaries in the United States. JAMA Intern Med. 2018; 178(12):1673-1680. PMC: 6583614. DOI: 10.1001/jamainternmed.2018.4720. View

20.

Salampessy B, Veldwijk J, Schuit A, van den Brekel-Dijkstra K, Neslo R, de Wit G . The Predictive Value of Discrete Choice Experiments in Public Health: An Exploratory Application. Patient. 2015; 8(6):521-9. PMC: 4662963. DOI: 10.1007/s40271-015-0115-2. View