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.