Older Adults' Readiness to Stop Prescribed Medications

Study Overview
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Brief Summary
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Polypharmacy, regular use of 5+ prescribed medications, is common among older adults and potentially harmful. Patients differ in their concern about medications, comfort in raising questions about them, and trust and confidence in physician judgment. This pilot observational research will determine older adults' readiness to deprescribe, that is, stop prescribed medications under physician guidance.

Detailed Description
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The purpose of this research is to assess readiness to deprescribe, that is, to determine how willing patients are to stop prescriptions that may no longer be necessary or may no longer have a favorable benefit-risk ratio. This readiness depends on many factors, including a patient's trust in a health care provider, how proactive patients are in seeking care, and patients' comfort in changing longstanding medical regimens. The proposed two-wave survey research will use validated instruments and recruit from an older adult research registry to determine (i) readiness to deprescribe at baseline, (ii) correlates of such readiness, and (iii) effects of intercurrent illness and changing health on readiness to deprescribe at 6 months. Specific aims: Determine readiness to deprescribe among a sample of patients with 5+ prescriptions using validated scales. Determine correlates of readiness to deprescribe. Patients differing in age, gender, race, education, and comorbidity may differ in willingness to stop prescribed medications. Determine the effect of intercurrent illness on readiness to deprescribe. Over 6 months, we anticipate some patients will have a new onset of illness or hospitalization, or increasing levels of disability. We would like to determine if these changes in medical status affect readiness to deprescribe.

Official Title
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Older Adults' Readiness to Stop Prescribed Medications With Guidance From Health Care Professionals

Conditions
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Polypharmacy, Decision-making

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 65 years or older Medical visit within past 6 months Self-report of at least 5 regular medications for at least 4 weeks Exclusion criteria: Diagnosis of dementia or score <=4 on Memory Impairment Screen Hospitalization in prior 30 days with change in medications

Ages Eligible for Study
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Minimum Age: 65 Years

Sexes Eligible for Study
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All

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Registry participants<br>Participants in the University of Pittsburgh Claude D. Pepper Center community research registry. Potential participants will have stable regimens of 5+ prescribed medications and recent physician contact but no hospitalization in the prior 6 months. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Patient Motivation to Deprescribe | Self-report measure (Linsky 2020): range 1-5; high scores = greater readiness to deprescribe; mean (SD) in VA sample 2.99 (0.80) | Change over 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Self-reported stopping/changing prescription medication | Self-report of stopping, tapering, or altering use of any prescription, with or without physician discussion | 6 months |