A new poll of older adults shows interest growing in the movement toward “deprescribing” medications.
A full 80 percent 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 percent said they have done so in the past two years.
Of those willing to stop a medicine, 67 percent 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.
“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.
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.
Describing can be challenging work for clinicians. In 2021, research scientists from Regenstrief Institute, Purdue University and Indiana University School of Medicine found that the vast majority of EHR alerts attempting to reduce the prescribing of high-risk medications linked to dementia in older adults went unread.
The goal of the intervention was to facilitate the deprescribing of anticholinergics through both provider and patient-based alerts. But engagement with the alerts was so low that the study team was unable to conclude if this approach could be an effective method.
Anticholinergic drugs affect the brain by blocking acetylcholine, a nervous system neurotransmitter that influences memory, alertness and planning skills. They are linked to dementia and prescribed for many conditions common in older adults including depression, urinary incontinence, irritable bowel syndrome and Parkinson's disease. These medications are used by approximately one in four older adults each year, and nearly half of older adults have used this type of medication at least once in a five-year period.
Many medical groups have come out in support of deprescribing anticholinergics, but it is challenging to execute in an already busy primary care environment, the researchers noted.
"Deprescribing is very complex and rarely prioritized over common medical problems during visits with primary care providers," said study lead author Noll Campbell, PharmD, M.S., research scientist at the IU Center for Aging Research at Regenstrief and assistant professor of pharmacy at Purdue University College of Pharmacy, in a statement. "In this study, we used principles of behavioral economics in the design of EHR nudges directed at both providers and patients to promote the deprescribing of high-risk anticholinergic medications. However, very few of the alerts were viewed by either recipient, so we are now evaluating how we can change or improve this approach."
The U-M poll has implications for many older adults, because it finds that 82 percent of people age 50 to 80 take at least one prescription medicine regularly. Of them, 28 percent say they believe they take too many medicines.
More than half of those polled take three or more prescription medications. In addition, 11 percent of those polled regularly take three or more over-the-counter medicines and 38 percent take three or more vitamins, minerals or supplements.
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 percent 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 adds. “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 a statement. “In our poll, cost was a driver behind stopping a medication for 15 percent 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 added.