Abstract
BackgroundFew studies have evaluated the characteristics of elderly patients with polypharmacy refusing deprescribing. The aim of this study was to evaluate the prevalence of potentially inappropriate medication (PIM) use in elderly patients accepting and refusing a deprescribing intervention and to investigate factors associated with deprescribing refusal.MethodsWe conducted a retrospective cross-sectional study by analyzing the electronic medical records from a single hospital. All consecutive patients aged 65 years or older who reported the use of five or more medications upon admission to the orthopedic ward from January 2015 to December 2016 and who were approached by a pharmacist for polypharmacy screening were included. Patients who had provided consent for the deprescribing intervention by the internal medicine physicians were defined as the acceptance group, and patients who did not were defined as the refusal group. The primary outcome was the use of any PIMs at admission, based on the 2015 American Geriatric Society Beers Criteria. Using multivariable logistic regression, predictive factors of refusing deprescribing were also evaluated.ResultsDuring the study period, 136 patients were eligible. Of those, 82 patients (60.3%) accepted the deprescribing intervention, and 54 patients (39.7%) declined the intervention. The mean age of all the patients was 81.1 years, and the mean number of medications at admission was 9.3. The overall proportion of patients taking any PIMs at admission was 77.2%. The proportion of patients taking any PIMs at admission was not different between the acceptance and refusal groups (78.0% and 75.9%, respectively; p = 0.84). None of the measured characteristics, including age, gender, residential status, comorbidity, alcohol use, smoking status, number of medications, or number of PIMs, were found to be associated with deprescribing refusal.ConclusionThe prevalence of any PIM use did not differ among elderly orthopedic patients with polypharmacy according to refusal or acceptance of the deprescribing intervention. Furthermore, none of the analyzed characteristics were found to be associated with deprescribing refusal. Given the high prevalence of PIM use, a strategy is needed for combating polypharmacy among elderly patients reluctant to undergo deprescribing.
Highlights
Few studies have evaluated the characteristics of elderly patients with polypharmacy refusing deprescribing
These studies lacked information regarding the appropriateness of medications among patients who refused deprescribing; this lack of information is problematic if the potentially inappropriate medication (PIM) prevalence for polypharmacy patients who refuse deprescribing is similar to or higher than the PIM prevalence for those who accept deprescribing
The mean number of medications at admission was 9.3. These demographic features were similar between the acceptance and refusal groups; the refusal group tended to have a higher proportion of current smokers compared with the acceptance group, this association was not statistically significant (p = 0.051)
Summary
Few studies have evaluated the characteristics of elderly patients with polypharmacy refusing deprescribing. Deprescribing is a systematic process of identifying and discontinuing drugs in instances in which existing or potential harms outweigh existing or potential benefits within the context of an individual patient’s care goals, current level of functioning, life expectancy, values, and preferences [7] It is uncertain whether deprescribing in elderly patients improves clinical outcomes, this strategy can safely and effectively reduce the use of potentially inappropriate medications (PIMs) [8,9,10]. This refusal rate seems overly high given that other recent studies evaluating elderly peoples’ attitudes regarding polypharmacy reported that 80–92% of participants are willing to have one or more medications deprescribed if their doctor said it was possible [17,18,19] This gap might reflect the difference between real-world practice and survey studies. Our aim was to evaluate PIM prevalence in elderly patients with polypharmacy who accept or refuse deprescribing as well as factors associated with deprescribing refusal
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