The Attitude of Older Patients to Deprescribing Polypharmacy in Ogun State, Nigeria

Authors

  • SA Saka
  • DO Odueke
  • O Odusan
  • OE Oyinloye
  • OL Okunye

DOI:

https://doi.org/10.30442/ahr.0804-07-182

Abstract

Background: Deprescribing has been suggested as a beneficial intervention to reduce polypharmacy among older patients. However, little is known about the willingness to accept this intervention among patients in resource-limited settings.

Objective: To evaluate the attitudes of older patients to deprescribing polypharmacy.

Methods: A quantitative, cross-sectional survey was carried out among consecutively selected ambulatory patients aged ≥65 years who were on ≥5 chronic medications in two secondary healthcare facilities in Ogun State, southwest Nigeria. The 22-item revised Patients Attitude Towards Deprescribing questionnaire was used to evaluate the participants' attitudes toward deprescribing, while another ten-question tool explored participants' sociodemographic and clinical data. Logistic regression was used to determine factors associated with willingness to deprescribe among the participants using the global question, "If my doctor said it was possible, I would be willing to stop one or more of my regular medicines”.

Results: Out of the 341 participants, the majority were females (60.7%), and 90.0% were on 5-7 medications. About three-quarters (71.8%) strongly agreed or agreed that they would be willing “to stop one or more of their medicines if the doctor said it was possible”. Female gender and caregivers’ involvement in medication management were significantly associated with participants' willingness to accept deprescribing (p = 0.07 and p = 0.01).

Conclusions: Most participants were willing to accept the deprescribing of their medications. Female gender and caregivers’ involvement in medication management were predictive factors for the participants' willingness to accept deprescribing.

References

Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in the elderly. Expert Opin Drug Saf 2014;13:57-65. https://doi.org/10.1517/14740338.2013.827660

Reeve E, Gnjidic D, Long J, Hilmer SJ Bjocp. A systematic review of the emerging definition of “deprescribing” with network analysis: implications for future research and clinical practice. Br J Clin Pharmacol 2015;80:1254–1268. https://doi.org/10.1111/bcp.12732

Page AT, Clifford RM, Potter K, Schwartz D, Etherton-Beer CD. The feasibility and effect of deprescribing in older adults on mortality and health: A systematic review and meta-analysis. Br J Clin Pharmacol 2016;82:583–623. https://doi.org/10.1111/bcp.12975

Reeve E, Wiese MD. Benefits of deprescribing on patients' adherence to medications. Int J Clin Pharm 2014;36:26–29. https://doi.org/10.1007/s11096-013-9871-z

Djatche L, Lee S, Singer D, Hegarty SE, Lombardi M, Maio V. How confident are physicians in deprescribing for the elderly and what barriers prevent deprescribing? J Clin Pharm Ther 2018;43:550-555. https://doi.org/10.1111/jcpt.12688

Reeve E, Low L-F, Shakib S, Hilmer SN. Development and validation of the revised patients’ attitudes towards deprescribing (rPATD) questionnaire: versions for older adults and caregivers. Drugs Aging 2016; 33:913–928. https://doi.org/10.1007/s40266-016-0410-1

Kalogianis MJ, Wimmer BC, Turner JP, Tan EC, Emery T, Robson L, et al. Are residents of aged care facilities willing to have their medications deprescribed? Res Social Adm Pharm 2016;12:784–788 https://doi.org/10.1016/j.sapharm.2015.12.004

Tegegn HG, Tefera YG, Erku DA, Haile KT, Abebe TB, Chekol F, et al. Older patients’ perception of deprescribing in resource-limited settings: a cross- sectional study in an Ethiopia university hospital. BMJ Open 2018;8:e020590. https://doi.org/10.1136/bmjopen-2017-020590

Shrestha S, Giri R, Sapkota HP, Danai SS, Saleem A, Devkota S, et al. Attitudes of ambulatory care older Nepalese patients towards deprescribing and predictors of their willingness to deprescribe. Ther Adv Drug Saf 2021;17;12:20420986211019309. https://doi.org/10.1177/20420986211019309.

Weir KR, Ailabouni NJ, Schneider CR, Hilmer SN, Reeve E. Consumer attitudes towards deprescribing: a systematic review and meta-analysis. J Gerontol 2022;77:1020-1034. https://doi.org/10.1093/gerona/glab222

United Nations. World population ageing 2017—highlights (ST/ESA/SERA/397).http://www.un.org/en/development/desa/population/publications/pdf/ageing/WPA2017_Highlights.pdf. Accessed 05 June 2018.

Saka S, Oosthuizen F, Nlooto M. National Policies and Older People’s Healthcare in Sub-Saharan Africa: A Scoping Review. Ann Glob Health 2019;85:91. https://doi.org/10.5334/aogh.2401

Borodo SB, Jatau AI, Mohammed M, Aminu N, Shitu Z, Sha’aban A. The burden of polypharmacy and potentially inappropriate medication in Nigeria: a clarion call for deprescribing practice. Bull Natl Res Cent 2022;46:178. https://doi.org/10.1186/s42269-022-00864-3

Charan J, Biswas T. How to calculate sample size for different study designs in medical research? Indian J Psychol Med 2013;35:121–126. https://doi.org/10.4103/0253-7176.116232

Rozsnyai Z, Jungo KT, Reeve E, Poortvliet RKE, Rodondi N, Gussekloo J, et al. What do older adults with multi-morbidity and polypharmacy think about deprescribing? The LESS study - a primary care-based survey. BMC Geriatr 2020;20:435. https://doi.org/10.1186/s12877-020-01843-x

Weir K, Nickel B, Naganathan V, Bonner C, McCaffery K, Carter SM, et al. Decision-making preferences and deprescribing: perspectives of older adults and companions about their medicines. J Gerontol B Psychol Sci Soc Sci 2017; 73: e98–e107. https://doi.org/10.1093/geronb/gbx138

Chung GS, Lawrence RE, Curlin FA, Arora V, Meltzer DO. Predictors of hospitalised patients' preferences for physician-directed medical decision-making. J Med Ethics 2012;38:77-82. https://doi.org/10.1136/jme.2010.040618

Kua KP, Saw PS, Lee SWH. Attitudes towards deprescribing among multi-ethnic community-dwelling older patients and caregivers in Malaysia: a cross-sectional questionnaire study. Int J Clin Pharm 2019;41:793–803. https://doi.org/10.1007/s11096-019-00829-z.

Aoki T, Yamamoto Y, Ikenoue T, Fukuhara S. Factors associated with patient preferences towards deprescribing: a survey of adult patients on prescribed medications. Int J Clin Pharm 2019;41:531–537. https://doi.org/10.1007/s11096-019-00797-4

Reeve E, Low L-F, Hilmer SN. Attitudes of older adults and caregivers in Australia toward Deprescribing. J Am Geriatr Soc 2019;67:1204–1210. https://doi.org/10.1111/jgs.15804

Awad A, Alhadab A, Albassam A. Medication-Related Burden and Medication Adherence Among Geriatric Patients in Kuwait: A Cross-Sectional Study. Front Pharmacol 2020;11:1296. https://doi.org/10.3389/fphar.2020.01296

Rochon PA, Petrovic M, Cherubini A, Onder G, O’ Mahony D, Sternberg SA, et al. polypharmacy, inappropriate prescribing, and deprescribing in older people: through a sex and gender lens. Lancet Healthy Longev 2021;2:e290–300. https://doi.org/10.1016/S2666-7568(21)00054-4

Reinhard SC, Levine C, Samis S. AARP Public Policy Institute. Home alone: family caregivers providing complex chronic care. 2012. https://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/home-alone-family-caregivers-providing-complex chronic-care-rev-AARP-ppi-health.pdf (Accessed 12 April 2021).

Downloads

Published

2022-12-23

Issue

Section

Original Research

Most read articles by the same author(s)