Robinson Michael, Mokrzecki Sophie, Mallett Andrew J
Townsville Institute of Health Research and Innovation, Townsville University Hospital, Douglas, QLD, Australia.
College of Medicine and Dentistry, James Cook University, Douglas, QLD, Australia.
NPJ Aging. 2024 Jan 23;10(1):6. doi: 10.1038/s41514-023-00132-2.
Polypharmacy, commonly defined as ≥5 medications, is a rising public health concern due to its many risks of harm. One commonly recommended strategy to address polypharmacy is medication reviews, with subsequent deprescription of inappropriate medications. In this review, we explore the intersection of older age, polypharmacy, and deprescribing in a contemporary context by appraising the published literature (2012-2022) to identify articles that included new primary data on deprescribing medications in patients aged ≥65 years currently taking ≥5 medications. We found 31 articles were found which describe the current perceptions of clinicians towards deprescribing, the identified barriers, key enabling factors, and future directions in approaching deprescribing. Currently, clinicians believe that deprescribing is a complex process, and despite the majority of clinicians reporting feeling comfortable in deprescribing, fewer engage with this process regularly. Common barriers cited include a lack of knowledge and training around the deprescribing process, a lack of time, a breakdown in communication, perceived 'abandonment of care', fear of adverse consequences, and resistance from patients and/or their carers. Common enabling factors of deprescribing include recognition of key opportunities to instigate this process, regular medication reviews, improving lines of communication, education of both patients and clinicians and a multidisciplinary approach towards patient care. Addressing polypharmacy requires a nuanced approach in a generally complex group of patients. Key strategies to reducing the risks of polypharmacy include education of patients and clinicians, in addition to improving communication between healthcare providers in a multidisciplinary approach.
多重用药通常被定义为同时服用≥5种药物，由于其存在诸多有害风险，已成为日益严重的公共卫生问题。一种常用的应对多重用药的策略是进行药物审查，随后停用不适当的药物。在本综述中，我们通过评估已发表的文献（2012 - 2022年），探讨在当代背景下老年人、多重用药和药物停用之间的交叉点，以识别那些包含关于≥65岁且目前服用≥5种药物的患者停用药物的新原始数据的文章。我们发现了31篇文章，这些文章描述了临床医生目前对药物停用的看法、已识别的障碍、关键促成因素以及药物停用的未来方向。目前，临床医生认为药物停用是一个复杂的过程，尽管大多数临床医生表示对药物停用感到放心，但定期参与这一过程的医生较少。常见的障碍包括缺乏关于药物停用过程的知识和培训、时间不足、沟通不畅、感觉“放弃护理”、担心不良后果以及患者和/或其护理人员的抵触。药物停用的常见促成因素包括认识到启动这一过程的关键机会、定期进行药物审查、改善沟通渠道、对患者和临床医生进行教育以及采用多学科方法进行患者护理。应对多重用药需要在一般复杂的患者群体中采取细致入微的方法。降低多重用药风险的关键策略包括对患者和临床医生进行教育，以及采用多学科方法改善医疗服务提供者之间的沟通。
