Reducing Polypharmacy in Older Adults

Among the older population, polypharmacy—the use of five or more medications—has skyrocketed. The issue lies in the fact that some meds lack any sort of indication, are used in way too high of a dose, or do more harm than good. These are considered “inappropriate.”

As a result, there has been a boost in an interest to begin deprescribing, which is when a patient either stops or decreases medication usage. However, this often varies across different countries, being that healthcare systems, pharma marketing, out-of-pocket costs, and society could play a role. 1

Having said that, a survey published in JAMA Network Open1 sought to answer the question of, what exactly are older adults’ attitudes toward deprescribing certain medications?

The aforementioned survey study was conducted in 17 primary care environments that spanned 14 countries from May 2022 to December 2023. The goal for each country was to sign up 100 patients, with requirements that patients be 65 years of age or older and are taking five or more different medications on a regular basis.

This survey featured a questionnaire centered around patients’ sociodemographic qualities; attitudes toward deprescribing; and confidence in their general practitioner (GP), along with a couple of questions from the Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire.

Overall, after needing to meeting specific qualifications—such as providing consent and filling out more than five questions—1,340 older adults participated, with 44% noting that they would want to to deprescribe one or more of their medications, but these percentages varied depending on the country.

The general trend was that those who cited both higher medication satisfaction and trust in their GP had lower odds of wanting to deprescribe certain meds. Further, 82% of patients were satisfied with their medications, but out of the total sample size, participants were reportedly taking an average of seven meds.

The three most reported medications that patients would like to have deprescribed were diuretics (111 of 1,002 medications [11%]), lipid-modifying agents (109 of 1,002 medications [11%]), and agents that act on the renin-angiotensin system (83 of 1,002 medications [8%]).

From a geographic perspective, Poland and Italy had the highest proportion of patients who would like to deprescribe, while Bulgaria and Croatia had the lowest.

Overall, the study investigators concluded that, “the results from this study are informative for the development of future deprescribing interventions. The observed variation in patients wanting to deprescribe across countries demonstrates that patient-facing intervention materials might be more impactful when adjusted to local context. When designing future deprescribing interventions, the types of medications patients would like to deprescribe should be considered and weighted in conjunction with the prescriber’s expertise and guidelines. Medications whose benefits are challenging to estimate in older adults, such as preventative agents (eg, lipid-modifying agents) and psychotropics, were often named for deprescribing.

“Educational material for patients and decision aids may support shared decision-making, especially when the benefits of certain treatments are uncertain. The association between patients’ satisfaction with medications, trust in their GP, and interest in deprescribing specific medications highlights the importance of patient-practitioner communication in deprescribing. Future research should aim at better understanding the relationship between trust and patient-practitioner relationships and how this influences the implementation of deprescribing decisions in real-world clinical settings.”

Reference

1. Vidonscky Lüthold R, Jungo KT, Weir KR, et al. Older Adults’ Attitudes Toward Deprescribing in 14 Countries. JAMA Netw Open. 2025;8(2):e2457498. doi:10.1001/jamanetworkopen.2024.57498