Exploring the Barriers and Facilitators of Deprescribing in Older Adults: Qualitative Study of Patients and Geriatrics Experts.

Abstract

Background: South Korea is experiencing a rapid increase in the proportion of older adults, leading to a higher prevalence of multimorbidity and polypharmacy. Potentially inappropriate medication (PIM) use among older adults is a growing concern. This study explored the experiences and perceptions of older adults with polypharmacy and PIM and healthcare professionals regarding deprescribing, focusing on barriers, and facilitators.

Methods: A qualitative study was conducted from May to August 2023. Participants included 24 older adults aged ≥ 65 years with polypharmacy (≥ 5 medications) and at least one PIM, recruited from tertiary hospitals in South Korea. In-depth interviews were conducted three months after a deprescribing intervention to assess perceptions, experiences, and intervention sustainability. Focus group interviews were also conducted with geriatric healthcare professionals to explore their perspectives on deprescribing.

Results: Participants reported visiting multiple healthcare institutions and receiving prescriptions for various conditions and symptoms, resulting in polypharmacy. They had low awareness of the potential harms of polypharmacy and PIMs. Factors influencing polypharmacy included multimorbidity, symptom relief, health beliefs, and healthcare system factors. Participants emphasized the need for raising public awareness, improving prescribing practices, and implementing a geriatric primary care system. Geriatrics experts highlighted the challenges of deprescribing within the current healthcare system and the lack of systematic support for medication management.

Conclusion: Addressing barriers to deprescribing in South Korea requires a multifaceted approach, including public awareness campaigns, healthcare provider education, prescription sharing systems, and a geriatric primary care system. Long-term policies incentivizing appropriate medication use and supporting deprescribing interventions are necessary for sustainable medication management in older adults.