Lundby Carina, Glans Peter, Simonsen Trine, Søndergaard Jens, Ryg Jesper, Lauridsen Henrik Hein, Pottegård Anton
Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark.
OPEN, Open Patient data Explorative Network, Odense University Hospital, Odense C, Denmark.
J Am Geriatr Soc. 2021 Jun;69(6):1508-1518. doi: 10.1111/jgs.17054. Epub 2021 Feb 17.
BACKGROUND/OBJECTIVES: Successful deprescribing requires insight into patients' thoughts about deprescribing. We described attitudes towards deprescribing in a large sample of geriatric patients and nursing home residents.
Interview-based questionnaire study.
Denmark.
Geriatric inpatients (n = 44), geriatric outpatients (n = 94), and nursing home residents (n = 162) with an Orientation-Memory-Concentration score of ≥8.
Participants completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire by interview. Attitudes were reported descriptively, and rPATD factor scores were compared between participant groups and across participant characteristics.
Participants had a median age of 82 years (interquartile range [IQR] 76-89) and used a median of 8 medications (IQR 5-10). Thirty-three percent of participants would like to try stopping one of their medications on their own, while 87% were willing to stop one on their physician's advice. Geriatric inpatients reported slightly greater perceived burden of taking medication compared to geriatric outpatients and nursing home residents (median "burden" score 50 vs 42, p = 0.11), while geriatric outpatients reported slightly more involvement in their medication use compared to nursing home residents (median "involvement" score 80 vs 75, p < 0.05) and geriatric inpatients (median "involvement" score 80 vs 70, p < 0.01). An increasing number of medications was associated with an increased "burden" score (p = 0.001): Those using 1-4 medications daily had a median score of 25 (IQR 17-33) compared to 58 (IQR 42-75) among those using ≥10 medications daily. Similarly, an increasing number of medications was associated with a higher "concerns about stopping" score (p = 0.001) and a lower "appropriateness" score (p < 0.001), respectively.
Geriatric patients and nursing home residents are generally open towards deprescribing, particularly if proposed by their physician. Some differences exist between populations and across individual patient characteristics. Clinicians should increase awareness of deprescribing as a possibility in these populations and tailor their deprescribing approach to the individual patient.
背景/目的：成功减药需要了解患者对减药的看法。我们描述了大量老年患者和养老院居民对减药的态度。
基于访谈的问卷调查研究。
丹麦。
简易精神状态检查表得分≥8分的老年住院患者（n = 44）、老年门诊患者（n = 94）和养老院居民（n = 162）。
参与者通过访谈完成经验证的丹麦语版修订版患者对减药的态度（rPATD）问卷。对态度进行描述性报告，并比较参与者组之间以及不同参与者特征的rPATD因子得分。
参与者的中位年龄为82岁（四分位间距[IQR]76 - 89），平均使用8种药物（IQR 5 - 10）。33%的参与者想自行尝试停用一种药物，而87%的参与者愿意根据医生的建议停用一种药物。与老年门诊患者和养老院居民相比，老年住院患者报告的用药负担略高（中位“负担”得分50对42，p = 0.11），而与养老院居民相比，老年门诊患者报告在用药方面的参与度略高（中位“参与度”得分80对75，p < 0.05），与老年住院患者相比也是如此（中位“参与度”得分80对70，p < 0.01）。药物数量增加与“负担”得分增加相关（p = 0.001）：每天使用1 - 4种药物的患者中位得分为25（IQR 17 - 33），而每天使用≥10种药物的患者中位得分为58（IQR 42 - 75）。同样，药物数量增加分别与更高的“停药担忧”得分（p = 0.001）和更低的“适宜性”得分（p < 0.001）相关。
老年患者和养老院居民总体上对减药持开放态度，尤其是医生提出时。不同人群之间以及不同个体患者特征之间存在一些差异。临床医生应提高对这些人群进行减药的认识，并根据个体患者调整减药方法。
