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Choosing the right words

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Doctors must choose their words carefully when “deprescribing” medicines their senior patients may have come to depend on. (Source: Adobe Stock)

As people get older, their physical condition changes – and so should the medications they take, according to the American Geriatrics Society. 

That’s because the aging process affects how well medications are absorbed, how they are metabolized, and how long they take to leave the body. In general, older adults require lower doses of medications than younger adults, while some drugs may lose their benefits or even become harmful over time.  

When older patients no longer need certain medications or need less to have the same effect, doctors “deprescribe” them. However, getting patients to accept these changes requires their doctors to choose their words carefully, say researchers from Johns Hopkins Medicine.

They conducted a study of more than 800 adults over 65, in which they shared two scenarios with participants: one involved a patient taking a cholesterol-lowering medication to prevent serious problems such as heart attacks or strokes, and the other involved a sleep medicine being taken for insomnia which was bothersome, but not life-threatening. The participants were asked to choose from seven different phrases that a doctor could use to explain his or her recommendation for deprescribing.

The findings showed that patients were more likely to agree to stop taking both the statin medication and the sleeping pill when doctors specifically discussed their increased risk of side effects as a result of aging and co-existing health problems if they kept taking them. In contrast, they were less likely to agree to stop taking the statin when doctors used a phrase like, “I think we should focus on how you feel now rather than thinking about things that might happen years down the road.” They also were more hesitant to stop the sleeping pill when told, “This medicine is unlikely to help you function better.”

The Johns Hopkins team is currently developing and testing several interventions to improve both prescribing and deprescribing medications for older adults in primary care, especially those living with memory problems or dementia. 

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