"Deprescribing" medicines for older adults: Patient-provider dialogue needed

Majority of people over 50 are open to stopping one or more of their medications – but some of those who already did so didn’t talk with a health provider first

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Author | Kara Gavin

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As the movement toward “deprescribing” medications among older adults grows, a poll shows strong interest in this idea.

A full 80% of adults aged 50 to 80 would be open to stopping one or more of the prescription medicines they’ve been taking for more than a year, if a health care provider said it was possible. Already, 26% said they have done so in the past two years.

Of those willing to stop a medicine, 67% said they would likely ask for advice about doing so at their next visit with a provider, according to the new findings from the University of Michigan National Poll on Healthy Aging.

But the poll also shows the importance of communication between patients and providers when deprescribing – a concept that includes both decreasing and stopping a medication because a temporary health condition has resolved, the medicine might clash with others, or the overall benefits and risks of taking it have changed.

SEE ALSO: Older adults are missing out on a crucial medication review service (michiganmedicine.org)

“Deprescribing, which can include prescription medications, over-the-counter medications, and dietary supplements, should be based on dialogue between patients and providers, and sometimes family members,” said Sarah Vordenberg, Pharm.D., M.P.H., a U-M College of Pharmacy clinical associate professor who worked on the poll.

interest in stopping prescription medication among adults age 50-80 among those who take prescription medication: 80% are willing to stop taking one or more medications if their health care provider said it was possible 26% had stopped taking at least one prescription medication taken for more than a year 82% take prescription medication
Credit: IHPI

More than a third of older adults who said they had stopped taking a prescription medicine they’d been on for more than a year, and didn’t start on a replacement for it, said they did so without talking with a health professional such as a doctor, pharmacist or nurse practitioner.

The poll is based at the U-M Institute for Healthcare Policy and Innovation and supported by AARP and Michigan Medicine, the University of Michigan’s academic medical center.

The poll has implications for many older adults, because it finds that 82% of people age 50 to 80 take at least one prescription medicine regularly. Of them, 28% say they believe they take too many medicines.

More than half of those polled take three or more prescription medications. In addition, 11% of those polled regularly take three or more over-the-counter medicines and 38% take three or more vitamins, minerals or supplements.

Medication reviews needed

The poll suggests more people should take advantage of a little-known benefit offered by Medicare and other insurance: a comprehensive medication review by a pharmacist or other provider.

“While we found that over 90% of older adults who take at least one prescription medicine expect their provider to review their list of medicines at least annually, research has shown this is often not the case,” Vordenberg added. “This drives home the importance of comprehensive medication reviews, which can often be billed to insurance by clinics and pharmacies as a separate patient encounter.”

“Another key aspect of deprescribing conversations and comprehensive medication reviews should be cost, because inability to afford medications can lead people to stop taking or alter the dose of medications that are important to their health,” said poll director Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.  “In our poll, cost was a driver behind stopping a medication for 15% of older adults with health or disability issues that limit their daily activities, twice as high as the percentage for those without these conditions,” he says. 

While we found that over 90% of older adults who take at least one prescription medicine expect their provider to review their list of medicines at least annually, research has shown this is often not the case."

- Sarah Vordenberg, Pharm.D., M.P.H.

People with a health problem or disability that limits their usual activities, and those who said they were in fair or poor physical or mental health, were also nearly twice as likely overall to say they had stopped taking a medication in the past two years, compared to those in better health.

More than a third (38%) of those taking five or more prescription medications also said they had stopped taking a medication, compared with 23% of those taking three to four prescription medications and 17% of those taking one to two prescription medications. 

In 2020, a previous report from the National Poll on Healthy Aging found that 24% of adults age 50 to 80 who take two or more prescription drugs, and 25% of those who have Medicare Part D prescription drug plans, had had a comprehensive medication review. The vast majority of those who had not had a CMR were unaware that their insurance might cover the cost of such a review.

SEE ALSO: Troubling Trio: Many with Dementia Take Risky Combinations of Medicines

“Adults ages 65 and older take 4.6 medications per month on average,” said Susan Reinhard, Senior Vice President at AARP Public Policy Institute. “It’s important that patients not only have regular communication about the risks and benefits of each prescription with health care providers, but also with loved ones and family caregivers. Research shows improved outcomes when family members help make decisions in the deprescribing process.”

The poll report is based on findings from a nationally representative survey conducted by NORC at the University of Chicago for IHPI and administered online and via phone in January 2023 among 2,563 adults aged 50 to 80. The sample was subsequently weighted to reflect the U.S. population. For the previous poll, a different sample of older adults was asked about medication use and comprehensive medication reviews, but both samples were weighted to reflect the population of U.S. adults aged 50 to 80.

Read past National Poll on Healthy Aging reports and about the poll methodology.

More Articles About: Pharmacy Medication Guidelines Medication Interactions Hospitals & Centers Community Health Geriatrics
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