450 Barriers and Enablers to Medication Deprescribing among Older patients attending a Geriatric Clinic in Southwestern Nigeria: A Cross-Sectional Study
Authors: Akande-Sholabi W , Ajilore C O , Olowookere O O , Adebusoye L A 
Published: April 2023

Abstract

Introduction
Polypharmacy is an increasing health problem, leading to rise in morbidity and mortality, especially among older patients. Deprescribing has been recommended for managing polypharmacy, but deprescribing medication in older patients is still uncommon (1). Safe deprescribing interventions can reduce exposure to inappropriate polypharmacy among older patients. However, few empirical data exist on the barriers and enablers to medication deprescribing among older patients in sub-Saharan African countries.

Aim
This study aimed to assess the barriers and enablers of medication deprescribing among older patients.

Methods
A cross-sectional study of 415 older patients aged ≥60 years, selected consecutively at the geriatric clinic in a Tertiary Hospital was carried out between May and July 2022. An interviewer-administered semi-structured questionnaire was used to obtain information on their socio-demographic characteristics, and barriers and enablers of medication deprescribing were assessed with modified Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire (2). Descriptive analyses were carried out using SPSS 23.

Results
The mean age of the respondents was 69.6 ± 6.4 years and 252 (60.7%) were females. There were 218 (52.5%) respondents with multimorbidity (≥2 medical conditions), and 126 (30.4%) with polypharmacy (≥ 5 medications). Cardiovascular disease 331 (81.0%), and endocrine system disease 111 (26.7%) were the most common disease condition. The enablers to deprescribing were willing to stop one or more regular medicines, if recommended by a physician 251 (60.5%), and willing to stop if the medicines can be restarted in the future if needed 205 (49.4%). While the barriers were would be worried about missing out on medicine benefits 78 (18.8%) and would be reluctant to stop medicines prescribed by a physician 63 (15.2%).

Conclusion
The older patients were receptive to deprescribing. Satisfaction with medicines and trust in physician’s recommendations are important factors influencing patients’ willingness to have their medicines deprescribed.The most common barrier was worries about missing out on medicine benefits.These findings calls for healthcare professionals to focus on communication strategies to facilitate shared decision-making regarding medication use and deprescribing with patient and family. Improvement in deprescribing through interdisciplinary approach may improve clinical outcomes.

References
1. Crutzen S, Baas G, Abou J, van der Born-Bondt T, Hugtenburg JG, Bouvy ML, Heringa M, Taxis K, Denig P. Barriers and Enablers of Older Patients to Deprescribing of Cardiometabolic Medication: A Focus Group Study. Frontiers in Pharmacology. 2020 11:1268. doi:10.3389/fphar.2020.01268.
2. Reeve E, Low L F, Shakib S, Hilmer S N. Development and Validation of the Revised Patients’ Attitudes Towards Deprescribing (rPATD) Questionnaire: Versions for Older Adults and Caregivers. Drugs Aging. 2016; 33 (12):913–928. doi: 10.1007/s40266-016-0410-1. PMID: 27785734.