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Collaborative Provider-Patient Communication Is Essential When Reducing Multiple Medications, Study Finds

For Immediate Release
December 7, 2017

Contact: Todd Kluss
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Australian researchers have developed a system to help doctors identify older patients who are open to “deprescribing” — a process where medicines are reviewed in order to reduce or stop those that are unneeded, less-effective, or problematic.

This work is reported in “Decision-Making Preferences and Deprescribing: Perspectives of Older Adults and Companions About Their Medicines,” a new article published online in The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences.

“Polypharmacy in the older population is increasing and can be harmful, said lead author Kristie Weir, BSc, MPH, who is based at the University of Sydney School of Public Health. “It can be safe to reduce or carefully cease medicines, but a collaborative approach between patient and doctor is required.”

She added that deprescribing isn’t new, but there has been a recent explosion of research in this area showing how it can be done safely and in collaboration with patients.

“We provide a novel approach to describe these differences between older people who are happy to take multiple medicines, and those who are open to deprescribing,” Weir said. “Ultimately, considering these variations in attitudes towards medicines and openness to deprescribing could improve communication between clinicians and their patients.

Weir and her colleagues categorized three distinct types of people that could help guide the type of advice given by clinicians to older patients when discussing the issues around taking multiple medicines. They reported that recognizing these three types of patients can help clinicians tailor their communication approaches.

Type one:
These people are resistant to deprescribing and are very attached to their medications because they are perceived as highly important to their well-being. Members of this group like to be informed but ultimately prefer to leave decisions about medicines to doctors.

Type two:
These people indicated they were open to deprescribing and preferred an active role in decision making to share responsibility with their doctor. They would consider deprescribing and said they didn’t like the idea of completely relying on medications to stay healthy. Members of this group have mixed attitudes towards medicines, valuing their benefit but disliking the side effects and hassle of taking them.

Type three:
These people were less engaged in decision making; most 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.

Weir said this research shows that doctors should tailor communication to individual older people who are taking multiple medicines in order to provide the best level of care.

“For some patients it might be that you need to help them think a bit more about their medicines and educate them more,” she said. “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.”

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The Journals of Gerontology, Series B: Psychological Sciences and Social Sciences is a peer-reviewed publication of The Gerontological Society of America (GSA), the nation's oldest and largest interdisciplinary organization devoted to research, education, and practice in the field of aging. The principal mission of the Society — and its 5,500+ members — is to advance the study of aging and disseminate information among scientists, decision makers, and the general public. GSA’s structure also includes a policy institute, the National Academy on an Aging Society, and an educational unit, the Association for Gerontology in Higher Education.

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