Barriers and enablers of older adults initiating a deprescribing conversation

Objective: To examine older adults’ perceptions and identify barriers and enablers to initiating a conversation about stopping medication(s) with their healthcare provider. 

Methods: We conducted one focus group (n = 3) and in-depth, face-to-face, individual interviews (n = 6) using an interview guide. Older adults aged ≥65 years in a retirement community who were taking ≥5 medications were recruited. Focus groups and interviews were audio-recorded and transcribed verbatim. Both a deductive analysis, informed by the Theoretical Domains Framework, and an inductive analysis were conducted. 

Results: Five themes and fourteen sub-themes were identified. Theme 1, ‘older adult-related barriers’, discusses limited or varying self-efficacy, past unsuccessful deprescribing experiences and limited familiarity with medications/deprescribing. Theme 2, ‘provider-related barriers’, discusses trust, short office visits, lack of communication and multiple providers. Theme 3, ‘environmental/social-related barriers’, involves limited availability of resources and access to telehealth/internet. The remaining themes (Themes 4–5) identified enablers including strategies to promote older adults’ self-efficacy and improved healthcare communication. 

Conclusion: Consumer-centric tools could improve older adults’ self-efficacy to initiate deprescribing conversations. Practice Implications: Removing barriers and implementing enablers may empower older adults to initiate deprescribing conversations with providers to take fewer medications. Ultimately, this could be a catalyst for increased translation of deprescribing in practice.