(113) Exploring the Association Between Intention and Action in Deprescribing

Background: Older Americans frequently receive unnecessary and potentially risky medications, leading to preventable harms such as adverse drug reactions, falls, hospitalization, and death. Previous research has shown that most older Americans are open to deprescribing.

Objectives: The study objective was to determine whether the individuals’ attitude towards deprescribing predicts the likelihood of stopping potentially inappropriate medications (PIM), for which potential risks outweigh benefits or safer alternatives exist.

Methods: This retrospective cohort study used the National Health and Aging Trends Study (NHATS) linked to Medicare Part D data. The study cohort included fee-for-service Medicare beneficiaries 65 years and older who completed the Patients' Attitudes Towards Deprescribing (PATD) questionnaire in NHATS. All individuals who used at least one PIM in the six months before completing the PATD (index date) were included in the cohort. Two PATD questions measured intention to deprescribe: (1) “if my doctor said it was possible, I would be willing to stop one or more of my regular medicines”; and (2) “I would like to reduce the number of medicines I am taking.” The outcome of interest was PIM discontinuation in the six months after the index date. We used multivariate logistic regression to calculate the association between responses to each of the two PATD questions and PIM discontinuation while controlling for age, sex, race/ethnicity, dementia, number of chronic conditions, polypharmacy and activities of daily living.

Results: Of the 1,938 participants who completed the PATD and had Medicare Part D, 694 took a PIM in the 6 months before the index date (average 1.6 PIM per person). The 4 most common PIM classes were opioids (number of people, n=315), proton pump inhibitors (n=207), antiepileptics (n=163), and benzodiazepines (n=142). A total of 637 (92%) participants reported being willing to stop taking 1 or more of their medicines if their physician said it was possible, and 483 (70%) participants wanted to reduce the number of medicines they were taking. Neither PATD question was significantly associated with PIM discontinuation. Being willing to stop taking 1 or more medicine (adjusted odds ratio 2.97, 95% CI, 0.33-27.03), and wanting to reduce the number of medicines (adjusted odds ratio 0.80, 95% CI, 0.33-1.92) was not associated with PIM discontinuation in general or for the 4 most common PIM classes.

Conclusions: Neither PATD item predicts subsequent PIM discontinuation, revealing a mismatch between patients' interest in deprescribing and deprescribing in real-world conditions