Skip to main content
Top
Published in: International Journal of Clinical Pharmacy 5/2015

01-10-2015 | Research Article

Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia

Authors: Katie Qi, Emily Reeve, Sarah N. Hilmer, Sallie-Anne Pearson, Slade Matthews, Danijela Gnjidic

Published in: International Journal of Clinical Pharmacy | Issue 5/2015

Login to get access

Abstract

Background Deprescribing is the process of medication withdrawal with the aims of reducing the harms of potentially inappropriate medication use and improving patient outcomes. Deprescribing of statins may be indicated for some older people, because the evidence for benefit in primary prevention of cardiovascular disease is limited and there is an increased risk of side effects in old age. Objective To determine older peoples’ attitudes and beliefs regarding medication use and their willingness to have regular medications, particularly statins, deprescribed. Setting An Australian acute-care hospital. Method A cross-sectional study of patients admitted to a teaching hospital in Sydney, Australia, aged ≥65 years and taking a statin was conducted. Attitudes and beliefs regarding medication use and willingness to have medications or statins deprescribed were captured using the validated Patients’ Attitudes Towards Deprescribing questionnaire, supplemented with additional statin-specific questions. Main outcome measures. Older inpatients’ attitudes and perspectives towards stopping medications, in particular statins. Results Overall, 180 participants were recruited, with a median age of 78 years, (interquartile range 71–85). Eighty-nine percent (95 % CI 84.4–93.6) of participants reported that they would be willing to stop one or more of their regular medications if their doctor said it was possible. Ninety-five percent (95 % CI 91.8–98.2) agreed that they would be willing to have a statin deprescribed. Moreover, 94 % (95 % CI 90.5–97.5) of participants expressed concern regarding the potential side effects of taking a statin. Conclusion The majority of older inpatients using statins are willing to have one or more of their current medications, including statins, deprescribed. These findings can be used to inform clinical practice and interventional statin deprescribing studies to optimise medication use in older adults.
Literature
1.
go back to reference Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust. 2014;201(7):390–2.CrossRefPubMed Scott IA, Anderson K, Freeman CR, Stowasser DA. First do no harm: a real need to deprescribe in older patients. Med J Aust. 2014;201(7):390–2.CrossRefPubMed
3.
go back to reference Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. The benefits and harms of deprescribing. Med J Aust. 2014;201(7):386–9.CrossRefPubMed Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. The benefits and harms of deprescribing. Med J Aust. 2014;201(7):386–9.CrossRefPubMed
4.
go back to reference Le Couteur D, Banks E, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr. 2011;34(6):182–5. Le Couteur D, Banks E, Gnjidic D, McLachlan A. Deprescribing. Aust Prescr. 2011;34(6):182–5.
5.
go back to reference Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738–47.PubMedCentralCrossRefPubMed Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Review of deprescribing processes and development of an evidence-based, patient-centred deprescribing process. Br J Clin Pharmacol. 2014;78(4):738–47.PubMedCentralCrossRefPubMed
6.
go back to reference Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.CrossRefPubMed Garfinkel D, Mangin D. Feasibility study of a systematic approach for discontinuation of multiple medications in older adults: addressing polypharmacy. Arch Intern Med. 2010;170(18):1648–54.CrossRefPubMed
8.
go back to reference Williams ME, Pulliam CC, Hunter R, Johnson TM, Owens JE, Kincaid J, et al. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004;52(1):93–8.CrossRefPubMed Williams ME, Pulliam CC, Hunter R, Johnson TM, Owens JE, Kincaid J, et al. The short-term effect of interdisciplinary medication review on function and cost in ambulatory elderly people. J Am Geriatr Soc. 2004;52(1):93–8.CrossRefPubMed
9.
go back to reference Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015;49(1):29–38.CrossRefPubMed Reeve E, Andrews JM, Wiese MD, Hendrix I, Roberts MS, Shakib S. Feasibility of a patient-centered deprescribing process to reduce inappropriate use of proton pump inhibitors. Ann Pharmacother. 2015;49(1):29–38.CrossRefPubMed
10.
go back to reference Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of dutch gps. A qualitative study. BMC Fam Pract. 2012;13:56.PubMedCentralCrossRefPubMed Schuling J, Gebben H, Veehof LJ, Haaijer-Ruskamp FM. Deprescribing medication in very elderly patients with multimorbidity: the view of dutch gps. A qualitative study. BMC Fam Pract. 2012;13:56.PubMedCentralCrossRefPubMed
11.
go back to reference Dickinson R, Knapp P, House AO, Dimri V, Zermansky A, Petty D, et al. Long-term prescribing of antidepressants in the older population: a qualitative study. Br J Gen Pract. 2010;60(573):e144–55.PubMedCentralCrossRefPubMed Dickinson R, Knapp P, House AO, Dimri V, Zermansky A, Petty D, et al. Long-term prescribing of antidepressants in the older population: a qualitative study. Br J Gen Pract. 2010;60(573):e144–55.PubMedCentralCrossRefPubMed
12.
go back to reference Mazor KM, Velten S, Andrade SE, Yood RA. Older women’s views about prescription osteoporosis medication: a cross-sectional, qualitative study. Drugs Aging. 2010;27(12):999–1008.CrossRefPubMed Mazor KM, Velten S, Andrade SE, Yood RA. Older women’s views about prescription osteoporosis medication: a cross-sectional, qualitative study. Drugs Aging. 2010;27(12):999–1008.CrossRefPubMed
13.
go back to reference Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA. Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor–positive breast cancer. J Clin Oncol. 2004;22(16):3309–15.CrossRefPubMed Fink AK, Gurwitz J, Rakowski W, Guadagnoli E, Silliman RA. Patient beliefs and tamoxifen discontinuance in older women with estrogen receptor–positive breast cancer. J Clin Oncol. 2004;22(16):3309–15.CrossRefPubMed
14.
go back to reference Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99(2):215–20.CrossRefPubMed Lash TL, Fox MP, Westrup JL, Fink AK, Silliman RA. Adherence to tamoxifen over the five-year course. Breast Cancer Res Treat. 2006;99(2):215–20.CrossRefPubMed
15.
go back to reference Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14.CrossRefPubMed Reeve E, Wiese MD, Hendrix I, Roberts MS, Shakib S. People’s attitudes, beliefs, and experiences regarding polypharmacy and willingness to deprescribe. J Am Geriatr Soc. 2013;61(9):1508–14.CrossRefPubMed
16.
go back to reference Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.CrossRefPubMed Morgan TK, Williamson M, Pirotta M, Stewart K, Myers SP, Barnes J. A national census of medicines use: a 24-hour snapshot of australians aged 50 years and older. Med J Aust. 2012;196(1):50–3.CrossRefPubMed
17.
go back to reference Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician. 2012;41(12):924–8.PubMed Hilmer SN, Gnjidic D, Le Couteur DG. Thinking through the medication list - appropriate prescribing and deprescribing in robust and frail older patients. Aust Fam Physician. 2012;41(12):924–8.PubMed
18.
go back to reference Roberts CG, Guallar E, Rodriguez A. Efficacy and safety of statin monotherapy in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62(8):879–87.CrossRefPubMed Roberts CG, Guallar E, Rodriguez A. Efficacy and safety of statin monotherapy in older adults: a meta-analysis. J Gerontol A Biol Sci Med Sci. 2007;62(8):879–87.CrossRefPubMed
19.
go back to reference Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;1:Cd004816.PubMed Taylor F, Huffman MD, Macedo AF, Moore TH, Burke M, Davey Smith G, et al. Statins for the primary prevention of cardiovascular disease. Cochrane Database Syst Rev. 2013;1:Cd004816.PubMed
20.
go back to reference Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ. 2013;347:f6123.CrossRefPubMed Abramson JD, Rosenberg HG, Jewell N, Wright JM. Should people at low risk of cardiovascular disease take a statin? BMJ. 2013;347:f6123.CrossRefPubMed
21.
go back to reference Berthold HK, Gouni-Berthold I. Lipid-lowering drug therapy in elderly patients. Curr Pharm Des. 2011;17(9):877–93.CrossRefPubMed Berthold HK, Gouni-Berthold I. Lipid-lowering drug therapy in elderly patients. Curr Pharm Des. 2011;17(9):877–93.CrossRefPubMed
22.
go back to reference Savarese G, Gotto AM Jr, Paolillo S, D’Amore C, Losco T, Musella F, et al. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2013;62(22):2090–9.CrossRefPubMed Savarese G, Gotto AM Jr, Paolillo S, D’Amore C, Losco T, Musella F, et al. Benefits of statins in elderly subjects without established cardiovascular disease: a meta-analysis. J Am Coll Cardiol. 2013;62(22):2090–9.CrossRefPubMed
23.
go back to reference Szadkowska I, Stanczyk A, Aronow WS, Kowalski J, Pawlicki L, Ahmed A, et al. Statin therapy in the elderly: a review. Arch Gerontol Geriatr. 2010;50(1):114–8.CrossRefPubMed Szadkowska I, Stanczyk A, Aronow WS, Kowalski J, Pawlicki L, Ahmed A, et al. Statin therapy in the elderly: a review. Arch Gerontol Geriatr. 2010;50(1):114–8.CrossRefPubMed
24.
go back to reference Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Development and validation of the patients’ attitudes towards deprescribing (patd) questionnaire. Int J Clin Pharm. 2013;35(1):51–6.CrossRefPubMed Reeve E, Shakib S, Hendrix I, Roberts MS, Wiese MD. Development and validation of the patients’ attitudes towards deprescribing (patd) questionnaire. Int J Clin Pharm. 2013;35(1):51–6.CrossRefPubMed
25.
go back to reference Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.CrossRefPubMed
26.
go back to reference Folstein MF, Folstein SE, McHugh PR. ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed Folstein MF, Folstein SE, McHugh PR. ”Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.CrossRefPubMed
27.
go back to reference Hilmer SN, Perera V, Mitchell S, Murnion BP, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.CrossRefPubMed Hilmer SN, Perera V, Mitchell S, Murnion BP, Dent J, Bajorek B, et al. The assessment of frailty in older people in acute care. Australas J Ageing. 2009;28(4):182–8.CrossRefPubMed
28.
go back to reference Gnjidic D, Le Couteur DG, Blyth FM, Travison T, Rogers K, Naganathan V, et al. Statin use and clinical outcomes in older men: A prospective population-based study. BMJ Open. 2013;3(3):e002333. Gnjidic D, Le Couteur DG, Blyth FM, Travison T, Rogers K, Naganathan V, et al. Statin use and clinical outcomes in older men: A prospective population-based study. BMJ Open. 2013;3(3):e002333.
29.
go back to reference Perreault S, Blais L, Dragomir A, Bouchard MH, Lalonde L, Laurier C, et al. Persistence and determinants of statin therapy among middle-aged patients free of cardiovascular disease. Eur J Clin Pharmacol. 2005;61(9):667–74.CrossRefPubMed Perreault S, Blais L, Dragomir A, Bouchard MH, Lalonde L, Laurier C, et al. Persistence and determinants of statin therapy among middle-aged patients free of cardiovascular disease. Eur J Clin Pharmacol. 2005;61(9):667–74.CrossRefPubMed
30.
go back to reference van Duijn HJ, Belo JN, Blom JW, Velberg ID, Assendelft WJ. Revised guidelines for cardiovascular risk management time to stop medication? A practice-based intervention study. Br J Gen Pract. 2011;61(587):e347–52.PubMedCentralCrossRefPubMed van Duijn HJ, Belo JN, Blom JW, Velberg ID, Assendelft WJ. Revised guidelines for cardiovascular risk management time to stop medication? A practice-based intervention study. Br J Gen Pract. 2011;61(587):e347–52.PubMedCentralCrossRefPubMed
31.
go back to reference Modig S, Kristensson J. Kristensson Ekwall A, Rahm Hallberg I, Midlöv P. Frail elderly patients in primary care—their medication knowledge and beliefs about prescribed medicines. Eur J Clin Pharmacol. 2009;65(2):151–5.CrossRefPubMed Modig S, Kristensson J. Kristensson Ekwall A, Rahm Hallberg I, Midlöv P. Frail elderly patients in primary care—their medication knowledge and beliefs about prescribed medicines. Eur J Clin Pharmacol. 2009;65(2):151–5.CrossRefPubMed
32.
go back to reference Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding statin use in america and gaps in patient education (usage): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6(3):208–15.CrossRefPubMed Cohen JD, Brinton EA, Ito MK, Jacobson TA. Understanding statin use in america and gaps in patient education (usage): an internet-based survey of 10,138 current and former statin users. J Clin Lipidol. 2012;6(3):208–15.CrossRefPubMed
33.
go back to reference Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311–6.CrossRefPubMed Mann DM, Allegrante JP, Natarajan S, Halm EA, Charlson M. Predictors of adherence to statins for primary prevention. Cardiovasc Drugs Ther. 2007;21(4):311–6.CrossRefPubMed
34.
go back to reference Reaume KT, Erickson SR, Dorsch MP, Dunham NL, Hiniker SM, Prabhakar N, et al. Effects of cerivastatin withdrawal on statin persistence. Ann Pharmacother. 2008;42(7):956–61.CrossRefPubMed Reaume KT, Erickson SR, Dorsch MP, Dunham NL, Hiniker SM, Prabhakar N, et al. Effects of cerivastatin withdrawal on statin persistence. Ann Pharmacother. 2008;42(7):956–61.CrossRefPubMed
35.
go back to reference Stack RJ, Elliott RA, Noyce PR, Bundy C. A qualitative exploration of multiple medicines beliefs in co-morbid diabetes and cardiovascular disease. Diabet Med. 2008;25(10):1204–10.CrossRefPubMed Stack RJ, Elliott RA, Noyce PR, Bundy C. A qualitative exploration of multiple medicines beliefs in co-morbid diabetes and cardiovascular disease. Diabet Med. 2008;25(10):1204–10.CrossRefPubMed
36.
go back to reference Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544.PubMedCentralCrossRefPubMed Anderson K, Stowasser D, Freeman C, Scott I. Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open. 2014;4(12):e006544.PubMedCentralCrossRefPubMed
37.
go back to reference Bernal DDL, Bereznicki LRE, Peterson GM. With great power comes great responsibility. Med J Aust. 2014;200(5):321.CrossRefPubMed Bernal DDL, Bereznicki LRE, Peterson GM. With great power comes great responsibility. Med J Aust. 2014;200(5):321.CrossRefPubMed
38.
go back to reference Kon RH, Russo MW, Ory B, Mendys P, Simpson RJ Jr. Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising. J Clin Lipidol. 2008;2(1):51–7.CrossRefPubMed Kon RH, Russo MW, Ory B, Mendys P, Simpson RJ Jr. Misperception among physicians and patients regarding the risks and benefits of statin treatment: the potential role of direct-to-consumer advertising. J Clin Lipidol. 2008;2(1):51–7.CrossRefPubMed
Metadata
Title
Older peoples’ attitudes regarding polypharmacy, statin use and willingness to have statins deprescribed in Australia
Authors
Katie Qi
Emily Reeve
Sarah N. Hilmer
Sallie-Anne Pearson
Slade Matthews
Danijela Gnjidic
Publication date
01-10-2015
Publisher
Springer Netherlands
Published in
International Journal of Clinical Pharmacy / Issue 5/2015
Print ISSN: 2210-7703
Electronic ISSN: 2210-7711
DOI
https://doi.org/10.1007/s11096-015-0147-7

Other articles of this Issue 5/2015

International Journal of Clinical Pharmacy 5/2015 Go to the issue