• Sarah E Vordenberg, Kristie Rebecca Weir, Jesse Jansen, Adam Todd, Nancy Schoenborn, and Aaron M Scherer.
• Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church St, 3563 NUB, Ann Arbor, MI, 48109, USA. skelling@med.umich.edu.
• J Gen Intern Med. 2023 May 1; 38 (6): 143914481439-1448.

BackgroundLittle is known about what factors are important to older adults when deciding whether to agree with a recommendation to deprescribe.ObjectiveTo explore the extent to which medication type and rationale for potential discontinuation influence older adults' acceptance of deprescribing.DesignCross-sectional 2 (drug: lansoprazole - treat indigestion; simvastatin - prevent cardiovascular disease) by 3 (deprescribing rationale: lack of benefit; potential for harm; both) experimental design.ParticipantsOnline panelists aged ≥65 years from Australia, the Netherlands, the United Kingdom, and the United States INTERVENTIONS: Participants were presented with a hypothetical patient experiencing polypharmacy whose PCP discussed stopping a medication. We randomized participants to receive one of six vignettes.Main MeasuresWe measured agreement with deprescribing (6-point Likert scale, "Strongly disagree (1)" and "Strongly agree (6)") for the hypothetical patient as the primary outcome. We also measured participants' personality traits, perceptions of risk and uncertainty, and attitudes towards polypharmacy and deprescribing.Key ResultsAmong 5311 participants (93.3% completion rate), the mean (M) agreement with deprescribing for the hypothetical patient was 4.71 (95% confidence interval (CI): 4.67, 4.75). Participants reported higher agreement with stopping lansoprazole (n=2656) (M=4.90, 95% CI: 4.85, 4.95) compared to simvastatin (n=2655) (M=4.53, 95% CI: 4.47, 4.58), P<.001. Participants who received the combination rationale (n=1786) reported higher agreement with deprescribing (M=4.83, 95% CI: 4.76, 4.89) compared to those who received the rationales on lack of benefit (n=1755) (M=4.66, 95% CI: 4.60, 4.73) or potential for harm (n=1770) (M=4.65, 95% CI 4.58, 4.72). In adjusted regression analyses (n=5062), participants with a higher desire to engage in health promotion behaviors (b=0.08, 95% CI 0.02, 0.13) or need for certainty (b=0.12, 95% CI 0.04, 0.20) reported higher agreement with deprescribing.ConclusionsOlder adults across four countries were accepting of deprescribing in the setting of polypharmacy. The medication type and rationale for discontinuation were important factors in the decision-making process.Trial RegistrationClinicalTrials.gov , NCT04676282, https://clinicaltrials.gov/ct2/show/NCT04676282?term=vordenberg&draw=2&rank=1.© 2022. The Author(s), under exclusive licence to Society of General Internal Medicine.

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