Geriatricians, internists, and cardiologists surveyed about deprescribing

As you grow older, you're more likely to develop health conditions that require taking multiple medications--some of which you may take for a long time. Many older people also take over-the-counter (or "OTC") medications, vitamins, or supplements as part of routine care. As a result, older adults have a higher risk of overmedication, also known as "polypharmacy"--the medical term for taking four or more medications at the same time. Polypharmacy can increase your chances of unwanted reactions (also called "adverse drug reactions") due to medications taken on their own or together.

To address this increasingly common problem, healthcare providers are focusing on how to reduce the number of medicines older adults are using through a practice called "deprescribing," which is when health professionals work with patients to decide to stop the use of one or more medications for which the benefits no longer outweigh the potential harms.

Getting both patients and health professionals on board with deprescribing can be key to its success, however. In order to learn more about physicians' attitudes and approaches to deprescribing medications for older adults, a team of researchers designed a survey. They published their investigation in the Journal of the American Geriatrics Society.

The researchers aimed to learn how frequently physicians from different specialties said they deprescribed cardiovascular medications (drugs for heart conditions) in their practices. Cardiovascular medications, such as blood thinners and medications for lowering blood pressure and cholesterol, are among the most commonly prescribed medication classes in the United States. Although the benefits of these medications for reducing heart attacks and stroke are proven, these treatments also have contributed to rising rates of polypharmacy and adverse drug events in older adults.

The research team was interested in learning why different specialists deprescribed some of these medications, and what difficulties they faced when they did so. The researchers also wanted to know about the priorities different specialties considered when deprescribing. The research team surveyed 750 geriatricians, general internists, and cardiologists.

The response rate to the survey was 26 percent for geriatricians, 26 percent for general internists, and 12 percent for cardiologists.

Over 80 percent of the physicians who responded reported that they had recently considered deprescribing a cardiovascular medication. Adverse drug reactions were the most common reason cited by all the specialties for deprescribing a drug.

Barriers to deprescribing were shared across specialties. One concern was about interfering with another physician's treatment plans, since some medications may be prescribed or recommended by several different providers who don't always work together. Another concern was patient reluctance to stop taking prescribed medications.

A majority of geriatricians (73 percent) said they might deprescribe a medicine that was not expected to benefit patients who had a limited life expectancy. This is compared to 37 percent of general internists and 14 percent of cardiologists.

More geriatricians (26 percent) reported concerns about cognition (the ability to think and made decisions) as a reason for deprescribing, compared to 13 percent of general internists and nine percent of cardiologists.

The researchers concluded that their survey showed that geriatricians, general internists, and cardiologists frequently consider deprescribing cardiovascular medications. They noted that successfully implementing patient-centric deprescribing will require improved communication between all physicians and their patients. "We hope our study will contribute to advancing deprescribing as a patient-centered strategy that can improve the safety of medication prescribing practice and improve the wellbeing of older adults," said the researchers.

If you take multiple medications, you may have questions about your own treatment plans and how they can be changed or improved to better suit your needs. HealthinAging.org offers a range of resources for learning more about how medications affect us differently as we age, as well as steps you can take to discuss medication management with your health professionals. Remember: Never discontinue using a prescribed treatment or make changes to your medications without speaking to a health professional first. If you experience a serious side effect or adverse event related to medications you may be taking, call 911 immediately.

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This summary is from "Physician Perspectives on Deprescribing Cardiovascular Medications for Older Adults." It appears online ahead of print in the November 2019 issue of the Journal of the American Geriatrics Society. The study authors are Parag Goyal, MD, MSc; Timothy S. Anderson, MD, MAS, MA; Gwen M. Bernacki, MD, MHSA; Zachary A. Marcum, PharmD, PhD; Ariela R. Orkaby, MD, MPH; Dae Kim, MD, MPH, ScD; Andrew Zullo, PharmD, PhD; Ashok Krishnaswami, MD, MAS; Arlene Weissman, PhD; Michael A. Steinman, MD; and Michael W. Rich, MD.

This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.

Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.

Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has--for 75 years--worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.