HSRAANZ Awards 2019 – Winner Best Qualitative Paper – Kristie Weir

Kristie's paper "Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions about their Medicines" was published in the Journal of Gerontology. It found that there are new ways to characterise older people who take multiple medicines and those who are open to "deprescribing". This is where medicines are reviewed with a view to reducing or stopping less effective medicines.

There has been an explosion of research in this area looking at deprescribing, how it can be done safely, and the barriers and enablers in this context.   The study provides a novel way to describe differences between older people who are happy to take multiple medicines, and those who are open to deprescribing.

The research revealed a Typology of three 'persona' of older adults taking multiple medicines and these personas can help guide the type of advice given by clinicians to older patients when discussing the problems of taking multiple medicines (called polypharmacy).

 

  • Type one people are very attached to their medications as they are perceived as highly important to their wellbeing and have negative attitudes towards any suggestion to consider stopping medicines (deprescribing). This group like to be informed but ultimately preferred to leave decisions about medicines to their doctor.
  • Type two people indicated they would consider deprescribing and said they didn't like the idea of completely relying on medications to stay healthy. Some patients also indicated they had a preference for being involved in decisions (shared decision making) about medicines and preferred to share responsibility with their doctor.
  • Type three people mostly deferred decisions about medicines to their doctor or companion. The people in this group had chronic health conditions and as such were taking a large number of medicines. They often didn't give much thought to medicines and are commonly unaware deprescribing is an option but were open to deprescribing if their doctor recommended it.

This research shows that doctors should tailor communication to individual older people on multiple medicines in order to provide the best level of care.

Recognising these three types of patients can help clinicians tailor their communication approaches. For some patients it might be that you need to help them think a bit more about their medicines and educate them more. Whereas for others, who were already aware of what medicines they were taking, identifying preferences and goals would be appropriate.

We need to develop ways to support clinicians and patients to have these important but challenging conversations.