This study found that half of the community-dwelling older adults were willing to stop one or more of their medications if their doctor said it was possible, and almost half were willing to cease a medication. These proportions were much lower than what prior investigations had reported. Reeve et al. showed that 92% and 89% of older adults in Australia were willing to have their medications deprescribed if their doctor said it was possible (14, 15). These differences could be explained by the fact that those surveyed were in better health. Indeed, Australia's median number of medications was 11 (15), but nearly 80% of patients in the current study took fewer than three medications. Also, the previous employment of the PATD found a potential positive correlation between trust in physician and willingness to cease a medication (16, 17). A study reported that in terms of the proportion of adults who agree with the statement, “All things considered, doctors in [your country] can be trusted.” About 73% of adults in Australia agree with this statement, and more than three fourths in Switzerland (83%), Denmark (79%), the Netherlands (78%), and Britain (76%) (ISSP 2011–2013) (18). However, in China, only 13.2% of patients strongly trust their doctors(19). Additionally, almost all participants had a firm belief in the necessity of their medications and thought they had a good understanding of the medicines they were taking, which could account for the discrepancy seen in this investigation.
We did not find participant age, the number of medications used, or the number of medical conditions to be associated with older adults' willingness to stop a medication. This is consistent with the PATD's prior findings that these factors did not have impact on successful benzodiazepine cessation (20). The current investigation could not identify characteristics that could select individuals who are more favorable toward deprescribing. This implies that to provide patient-centered care, all residents should be evaluated individually for deprescribing, regardless of how many medications they are taking or how old they are.
Chen et al. conducted a systematic review and meta-analysis of the impact of deprescribing interventions on clinical outcomes in the elderly patients (21). It demonstrated that specific or long-term follow-up (>6 months) deprescribing could reduce all-cause mortality among older patients with polypharmacy; deprescribing cannot reduce the number of patients who fall but can reduce the frequency of falls; and deprescribing can shorten hospitalization period. Also, a randomized experiment examining deprescribing in older hospitalized individuals found that reducing the use of potentially inappropriate medications can significantly lower medication costs (22). Therefore, deprescribing has been proven to be a successful method of addressing the problem of polypharmacy among patients.
As an emerging pharmacy term, deprescribing is not yet well understood and accepted by patients or even clinicians in China (21). Research shows that deprescribing is strongly influenced by patients' attitudes, with only 25%-33% of patients willing to implement deprescribing, indicating that raising public awareness of deprescribing is imperative (23, 24). According to the findings of this study, older adults should be informed about why medications may no longer be essential (i.e., that benefits and hazards might alter over time) and encouraged to discuss their medication concerns with their physicians or other health care providers through public education campaigns. However, increasing public knowledge of deprescribing does not take away the obligation of the physician for prescribing proper prescriptions (13).
Additionally, earlier research has revealed a possible association between physician trust and willingness to cease a medication. Therefore, Increased physician engagement in advocating therapy changes may contribute to a better acceptability of deprescribing (17). However, several studies have identified a variety of prescriber barriers to deprescribing (14, 25, 26). General practitioners claim that patients are resistant to medication withdrawal, preventing them from discussing the subject with their patients. This has been recognized as the primary contributor to inappropriate medication use among older adults (27). Also, deprescribing requires high levels of medical staff and isn't well supported by the clinical evidence (21).
We acknowledge several limitations. First, because the PATD questionnaire was initially developed and validated in Australia, there may be disparities in care delivery and the responsibilities of physicians, nurses, and pharmacists between Australia and China. Second, we only collected information on the number of medications not the type. The willingness of deprescribing is likely to vary based on the medication class and the medical condition for which it is prescribed. Lastly, as the participation was based on volunteers, participants may have better awareness and healthier than the general population, as well as more acceptive to relatively novel issues like deprescribing.
Further research is required to develop a deprescribing process, particularly in the areas of specific deprescribing based on individual, supporting physicians in deprescribing, and utilizing the broader health care system and governing policies to optimize medication use in China. To ascertain the safety and efficacy of the deprescribing, feasibility and implementation research will be needed, and long-term outcomes should be determined while taking economic factors into account.