Factors Important to Older Adults Who Disagree With a Deprescribing Recommendation.

Importance: Little is known about why older adults decline deprescribing recommendations, primarily because interventional studies rarely capture the reasons. Objective: To examine factors important to older adults who disagree with a deprescribing recommendation given by a primary care physician to a hypothetical patient experiencing polypharmacy. Design, Setting, and Participants: This online, vignette-based survey study was conducted from December 1, 2020, to March 31, 2021, with participants 65 years or older in the United Kingdom, the US, Australia, and the Netherlands. The primary outcome of the main study was disagreement with a deprescribing recommendation. A content analysis was subsequently conducted of the free-text reasons provided by participants who strongly disagreed or disagreed with deprescribing. Data were analyzed from August 22, 2022, to February 12, 2023. Main Outcomes and Measures: Attitudes, beliefs, fears, and recommended actions of older adults in response to deprescribing recommendations. Results: Of the 899 participants included in the analysis, the mean (SD) age was 71.5 (4.9) years; 456 participants (50.7%) were men. Attitudes, beliefs, and fears reported by participants included doubts about deprescribing (361 [40.2%]), valuing medications (139 [15.5%]), and a preference to avoid change (132 [14.7%]). Valuing medications was reported more commonly among participants who strongly disagreed compared with those who disagreed with deprescribing (48 of 205 [23.4%] vs 91 of 694 [13.1%], respectively; P < .001) or had personal experience with the same medication class as the vignette compared with no experience (93 of 517 [18.0%] vs 46 of 318 [12.1%], respectively; P = .02). Participants shared that improved communication (225 [25.0%]), alternative strategies (138 [15.4%]), and consideration of medication preferences (137 [15.2%]) may increase their agreement with deprescribing. Participants who disagreed compared with those who strongly disagreed were more interested in additional communication (196 [28.2%] vs 29 [14.2%], respectively; P < .001), alternative strategies (117 [16.9%] vs 21 [10.2%], respectively; P = .02), or consideration of medication preferences (122 [17.6%] vs 15 [7.3%], respectively; P < .001). Conclusions and Relevance: In this survey study, older adults who disagreed with a deprescribing recommendation were more interested in additional communication, alternative strategies, or consideration of medication preferences compared with those who strongly disagreed. These findings suggest that identifying the degree of disagreement with deprescribing could be used to tailor patient-centered communication about deprescribing in older adults.

Nurse educators' professional practice attributes and its determinants.

BACKGROUND: Professional practice attributes of nurses help to promote nursing as a profession and advance nursing education. Nursing professionals need to demonstrate a high level of professional commitment to their practices and must be professionally competent to perform their roles. MATERIAL AND METHODS: Descriptive survey was conducted at the nursing educational institutes affiliated with the Indian Nursing Council and situated in the selected Northern Indian states. The sample included 343 nurse educators who were selected using simple random sampling. The self-reported method was adopted to collect data where three questionnaires including socio-demographic information, organizational characteristics of current place of work, and professional practice attributes assessment criteria were used. Descriptive and inferential statistics were used for data analysis. RESULTS: Overall, the study's participants scored poorly on professional practice attributes (Mean, SD: 1.98, 2.03), which were linked to their personal (age and gender), professional (educational background, professional qualification, current designation), and organizational (duration of organization's establishment, courses provided, college management) characteristics. CONCLUSION: The findings highlighted the need for nurse educators to be more competent and dedicated in their respective fields. The study also suggests that in order to raise the standard of nursing education, nursing regulatory bodies like nursing councils, universities, and governments must take the necessary steps to foster the professional development of nurse educators.

Reasons why older adults in three countries agreed with a deprescribing recommendation in a hypothetical vignette.

The purpose of this study was to examine factors important to older adults who agreed with a deprescribing recommendation given by a general practitioner (GP) to a hypothetical patient experiencing polypharmacy. We conducted an online, vignette-based, experimental study in the United Kingdom, United States and Australia with participants ≥65 years. The primary outcome was an agreement with a deprescribing recommendation (6-point Likert scale; 1 = strongly disagree and 6 = strongly agree). We performed a content analysis of the free-text reasons provided by participants who agreed with deprescribing (score of 5 or 6). Among 2656 participants who agreed with deprescribing, approximately 53.7% shared a preference for following the GP's recommendation or considered the GP the expert. The medication was referred to as a reason for deprescribing by 35.6% of participants. Less common themes included personal experience with medicine (4.3%) and older age (4.0%). Older adults who agreed with deprescribing in a hypothetical vignette most frequently reported a desire to follow the recommendations given the GP's expertise. Future research should be conducted to help clinicians efficiently identify patients who have a strong desire to follow the doctor's recommendations related to deprescribing, as this may allow for a tailored, brief deprescribing conversation.

Older adults experiencing polypharmacy preferred to continue their non-prescription products during a card sorting activity.

OBJECTIVES: To explore the extent to which adults 65-years and older who reported taking 10 or more non-prescription products were interested in deprescribing. METHODS: During an online semi-structured interview, participants were asked to imagine their primary care provider raised the idea of deprescribing. Participants sorted each prescription and non-prescription medication into a category: continue, stop or lower (deprescribe), or unsure. Findings were summarized using descriptive statistics and thematic analysis. KEY FINDINGS: Participants (n = 15) were interested in deprescribing 6% of the non-prescription medications (n = 12/207). CONCLUSIONS: Older adults were resistant to deprescribing non-prescription products.

Older adults' willingness to consider deprescribing when experiencing hyperpolypharmacy.

BACKGROUND: 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. OBJECTIVES: The primary objective of our study was to use a card sorting activity to explore how older adults experiencing hyperpolypharmacy make hypothetical deprescribing decisions. METHODS: 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. RESULTS: 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%). CONCLUSION: 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.