Attitudes of Older Adults and Caregivers in Australia toward Deprescribing
Attitudes of Older Adults and Caregivers in Australia toward Deprescribing
复制标题
DOI：
10.1111/jgs.15804
复制
发表时间：
2019-06-01
影响因子：
6.3
通讯作者：
Hilmer, Sarah N.
中科院分区：
文献类型：
--
作者：
Reeve, Emily;Low, Lee-Fay;Hilmer, Sarah N.
背景/目的在老年人中使用有害和/或不必要的药物是很常见的。了解老年人和护理人员对处方的态度将有助于在实践中优化用药。本研究的目的是捕捉老年人和护理人员对处方解除的态度和信念，并确定哪些参与者的特征和/或态度（如果有的话）预测了报告的药物解除意愿。设计自填问卷。设置澳大利亚。参与者：年龄在65岁或以上，服用一种或多种常规处方药的老年人（386名）和老年人的照顾者（205名），他们可以用英语填写一份书面问卷。测量：完成老年人和护理人员版本的经验证的修订患者对处方减少的态度（rPATD）问卷。rPATD包括两个全球性问题和四个因素：感知到的药物负担、对药物适当性的信念、对停药的关注以及参与药物管理。参与者的特征、自评健康、对医生的信任和健康自主权也被收集。结果老年参与者的中位年龄为74岁（四分位数间距[IQR] = 70-81 y），护理者年龄为67岁（IQR = 59-76），照顾的是81岁的老年人（IQR = 75-86.25 y）。大多数老年人（88%）和照顾者（84%）同意或强烈同意，如果他们或他们的照顾者的医生说可能的话，他们愿意停止一种或多种他们或他们的照顾者的药物。在二元logistic回归模型中，对停止因子评分的低关注度是老年人处方药物意愿的最强预测因子（优势比[OR] = 0.12； 95%可信区间[CI] = 0.04-0.34）。优秀/良好的身体健康评分是护理人员的最强预测因子（OR = 3.71; 95% CI = 1.13-12.23）。结论：大多数老年人和护理人员愿意让他们或他们的护理对象开处方，尽管在这两组中发现了这种意愿的不同预测因素（特征/态度）。
BACKGROUND/OBJECTIVES Use of harmful and/or unnecessary medications in older adults is common. Understanding older adult and caregiver attitudes toward deprescribing will contribute to medication optimization in practice. The aims of this study were to capture the attitudes and beliefs of older adults and caregivers toward deprescribing and determine what participant characteristics and/or attitudes (if any) predicted reported willingness to have a medication deprescribed. DESIGN Self-completed questionnaire. SETTING Australia. PARTICIPANTS Older adults (n = 386), 65 years or older, taking one or more regular prescription medications and caregivers of older adults (n = 205) who could self-complete a written questionnaire in English. MEASUREMENTS Older adult and caregiver versions of the validated revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire were completed. The rPATD includes two global questions and four factors: perceived burden of medications, belief in appropriateness of medications, concerns about stopping, and involvement in medication management. Participant characteristics, self-rated health, trust in physician, and health autonomy were also collected. RESULTS Older adult participants had a median age of 74 years (interquartile range [IQR] = 70-81 y), and caregivers were aged 67 years (IQR = 59-76) and were caring for a person aged 81 years (IQR = 75-86.25 y). Most of both older adults (88%) and caregivers (84%) agreed or strongly agreed that they would be willing to stop one or more of their or their care recipient's medications if their or their care recipient's doctor said it was possible. In a binary logistic regression model, a low concern about stopping factor score was the strongest predictor of willingness to have a medication deprescribed in older adults (odds ratio [OR] = 0.12; 95% confidence interval [CI] = 0.04-0.34). Excellent/good rating of physical health was the strongest predictor in caregivers (OR = 3.71; 95% CI = 1.13-12.23). CONCLUSIONS Most older adults and caregivers are willing to have one of their or their care recipient's medication deprescribed, although different predictors (characteristics/attitudes) of this willingness were identified in these two groups.