Older adults’ willingness to consider deprescribing when experiencing hyperpolypharmacy

Older adults experiencing hyperpolypharmacy (use of 10 or more medications) are at an increased risk of cognitive impairment and functional decline. Deprescribing, where medications are stopped or tapered, is one strategy to mitigate risks. The primary objective of our study was to use a card sorting activity to explore how older adults experiencing hyperpolypharmacy make hypothetical deprescribing decisions. We recruited participants using our institutional research recruitment website between February and November 2020. Participant spoke with a research assistant to create a medication list and then completed an interview using card sorting activity to demonstrate how they would make hypothetical decisions about continuing or deprescribing their medications. Data from the card sorting activities and interviews were organized via Excel (Microsoft Corporation). We used the Pharmacy Quality Alliance Medication Therapy Problems Categories Framework to analyze participant’s reasons for considering deprescribing. The study was deemed exempt by the institutional review board. Among the 26 participants, 14 (54%) identified as female, 19 (73%) were white, and 24 (92%) reported good or very good health. Participants reported a total of 405 medications (average 16, range 10-30). A total of 19 participants (73%) were interested in deprescribing 94 medications (23%), including stopping 68 medications (72%) and lowering the dose or frequency of 26 medications (28%). Common rationales for wanting to stop a medication included perceived lack of indication (n = 30, 32%), adherence (general preference to not take the medication) (n = 20, 21%), lack of effectiveness (n = 17, 18%), and concerns about safety (n = 14, 15%). We were unable to categorize 13 rationales (14%). Most older adults experiencing hyperpolypharmacy were willing to consider deprescribing at least one medication. Future research is needed to identify whether a card sorting medication reflection activity can be used to provoke conversations about deprescribing between patients and primary care providers.