Attitudes towards deprescribing in geriatric psychiatry: A survey among older psychiatric outpatients.

Understanding the patient perspective is a significant part of the deprescribing process. This study aimed to explore the attitudes of older patients with psychiatric disorders towards deprescribing. A total of 72 of psychiatric outpatients (68% women; median age 76 years) completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Patients used a median of eight medications (interquartile range 6-12), with 88%, 49% and 24% using antidepressants, antipsychotics and anxiolytics, respectively. Fifty-one percent of patients reported an intrinsic desire to stop one of their medications, while 92% would be willing to stop one on their physician's advice. Seventy-five percent of patients would be worried about missing out on future benefits following deprescribing and 37% had previous bad deprescribing experiences. Use of ≥8 regular medications was associated with more concerns about stopping medication and greater perceived burden of using medication, while use of antipsychotics was not associated with any differences in rPATD factor scores. It is crucial for health care professionals to be aware of patients' specific concerns and past experiences to promote a patient-centred deprescribing approach that takes into account the needs and preferences of older patients with psychiatric disorders.

Attitudes towards deprescribing: The perspectives of geriatric patients and nursing home residents.

BACKGROUND/OBJECTIVES: Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents. DESIGN: Interview-based questionnaire study. SETTING: Denmark. PARTICIPANTS: Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8. MEASUREMENTS: Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics. RESULTS: Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (ptrend = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (ptrend  = 0.001) and a lower "appropriateness" score (ptrend < 0.001), respectively. CONCLUSION: Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.

Translation, cross-cultural adaptation, and validation of the Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire: Version for older people with limited life expectancy.

BACKGROUND: Knowledge about patients' attitudes towards deprescribing is essential for optimizing medication use. The revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire is a 22-item self-report instrument capturing older patients' beliefs and attitudes towards deprescribing. OBJECTIVES: To translate and cross-culturally adapt the rPATD questionnaire into Danish and subsequently validate it in a cohort of nursing home residents. METHODS: The rPATD questionnaire was translated and cross-culturally adapted during five stages of forward and backward translation. The validation study included 162 Danish nursing home residents (median age 84 years; 67% women). Validity was assessed through exploratory factor analysis (structural validity) and hypothesis testing (construct validity), while reliability was assessed through internal consistency. Floor and ceiling effects were examined. RESULTS: The exploratory factor analysis revealed a 4-factor structure similar to the original rPATD questionnaire, with items loading into four factors related to level of involvement in medication use, perceived burden of taking medication, belief in appropriateness of using medication, and concerns about stopping medication. The questionnaire was adjusted to the Danish nursing home population and health care system by omission of two items, concerning medication expenses and inconvenience of taking medication, which resulted in a model with factor loadings ranging from 0.29 to 0.84 and only minor cross-loading. Construct validity correctly predicted 67% of the hypothesized correlations. Internal consistency of all factors was generally acceptable with Cronbach's α ranging from 0.67 to 0.78. No floor and ceiling effects were identified. CONCLUSIONS: Results suggest that the Danish modified model of the rPATD questionnaire generally has acceptable validity and reliability.