Behavioral Determinants of Older Adults' and Caregivers' Willingness to Deprescribe: A Systematic Review.
Sara Alves Jorge, Stephan Van den Broucke, Ruth-Janet Koumba Maguena and 1 others
PMID 39740058WHAT IT FOUND
Patients and caregivers were more open to stopping medicines when they saw risk or side effects, felt medicines were no longer needed, and trusted their clinician.
Self-efficacy was the most consistent link to change after deprescribing interventions.
Key findings
01Older adults were more willing to deprescribe when they perceived medication risk or side effects, believed medicines were no longer needed, or had a good relationship with their GP.
02Barriers to deprescribing included being unsure how to stop, previous bad experience, thinking medicines are more helpful than harmful, and comfort with taking many medications.
03Across intervention studies, self-efficacy or perceived competence was the construct most consistently linked to post-intervention change, with social support also appearing important.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review combined very different study designs, medications, theories, and outcome measures, so it could not show which factor predicts deprescribing across all patients. Some included studies were of medium to poor quality, so the reported associations may be exaggerated. It excluded qualitative studies and studies using only the usual attitudes questionnaire unchanged, so it may miss patient reasons not captured by quantitative measures. It included studies with younger adults when they also included older adults, so the findings may not apply only to older adults. Intervention studies did not consistently use the theories they tested, so they cannot prove that changing self-efficacy caused deprescribing.
The easy way to misread this
Do not read this review as proof that nurse-led education or self-efficacy training will reduce medications. It mostly found associations from heterogeneous studies, and the included interventions varied in components and quality.