Gillespie Robyn, Mullan Judy, Harrison Lindsey
School of Medicine, University of Wollongong, Wollongong, NSW, Australia.
Centre for Health Research Illawarra Shoalhaven Population (CHRISP), Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia.
Prim Health Care Res Dev. 2019 Jun 20;20:e78. doi: 10.1017/S1463423618000919.
This study aimed to explore attitudes, beliefs and experiences regarding polypharmacy and discontinuing medications, or deprescribing, among community living older adults aged ≥65 years, using ≥5 medications. It also aimed to investigate if health literacy capabilities influenced attitudes and beliefs towards deprescribing.
Polypharmacy use is common among Australian older adults. However, little is known about their attitudes towards polypharmacy use or towards stopping medications. Previous studies indicate that health literacy levels tend to be lower in older adults, resulting in poor knowledge about medications.
A self-administered survey was conducted using two previously validated tools; the Patients' Attitude Towards Deprescribing (PATD) tool to measure attitudes towards polypharmacy use and deprescribing and the All Aspects of Health Literacy Scale (AAHLS) to measure functional, communicative and critical health literacy. Descriptive statistical analysis was conducted.
The 137 responses showed that 80% thought all their medications were necessary and were comfortable with the number taken. Wanting to reduce the number of medications taken was associated with concerns about the amount taken (P<0.001), experiencing side effects (P<0.001), or believing that one or more medications were no longer needed (P<0.000). Those who were using ten or more medications were more likely to want to reduce the number taken (P=0.019). Most (88%) respondents would be willing to stop medication/s in the context of receiving this advice from their doctor. Willingness to consider stopping correlated with higher scores on the critical health literacy subscale (P<0.021) and overall AAHLS score (P<0.009). Those with higher scores on the overall AAHLS measure were more likely to report that they understood why their medications were prescribed (P<0.000) and were more likely to participate in decision-making (P=0.027). Opportunities to proactively consider deprescribing may be missed, as one third of the respondents could not recall a recent review of their medications.
本研究旨在探讨年龄≥65岁、服用≥5种药物的社区老年人对于多重用药及停药（即减药）的态度、信念和经历。同时，研究健康素养能力是否会影响对减药的态度和信念。
多重用药在澳大利亚老年人中很常见。然而，对于他们对多重用药或停药的态度知之甚少。此前的研究表明，老年人的健康素养水平往往较低，导致对药物的了解不足。
使用两种先前经过验证的工具进行了一项自填式调查；即患者对减药的态度（PATD）工具，用于衡量对多重用药和减药的态度，以及健康素养综合量表（AAHLS），用于衡量功能、沟通和批判性健康素养。进行了描述性统计分析。
137份回复表明，80%的人认为他们所有的药物都是必要的，并且对所服用药物的数量感到安心。想要减少所服用药物的数量与对服药量的担忧（P<0.001）、经历副作用（P<0.001）或认为不再需要一种或多种药物（P<0.000）有关。服用十种或更多药物的人更有可能想要减少服药数量（P=0.019）。大多数（88%）受访者表示，在收到医生的此类建议后，他们愿意停药。考虑停药的意愿与批判性健康素养子量表的较高得分（P<0.021）和AAHLS综合得分（P<0.009）相关。在AAHLS综合测量中得分较高的人更有可能报告他们理解所开药物的原因（P<0.000），并且更有可能参与决策（P=0.027）。由于三分之一的受访者无法回忆起最近对其药物的复查，可能会错过主动考虑减药的机会。
