Older adults want to cut back on medication, but study shows need for caution

More than 82% of Americans age 50 to 80 take one or more kinds of prescription medication, and 80% of them say they’d be open to stopping one or more of those drugs if their health care provider gave the green light, a new University of Michigan study shows.

But it’s not as simple as that, the researchers say. They call for prescribers and pharmacists to talk with older adults about their personal situation and figure out if any kind of “deprescribing” is right for them.

The study, published in the Journal of General Internal Medicine, uses data from U-M’s National Poll on Healthy Aging, and builds on a poll report issued in April 2023.

It shows that about 30% of older adults who take medication to address cardiovascular disease or diabetes are most interested in deprescribing these medications. This might be because many of those drugs address symptomless risk factors such as high blood pressure, high cholesterol and high blood sugar.

Left uncontrolled, these risk factors can set the stage for future emergencies and crises. So medications to manage these conditions are important preventive tools.

However, older adults may not immediately feel the benefit of these medications, which may cause them to wonder if they continue to be needed.

In contrast, the study shows that older adults whose prescriptions address conditions that cause symptoms right now — including arthritis pain, mental health conditions and breathing issues —were less interested in stopping those medications.

The new study underscores the importance of comprehensive medication reviews, says Sarah Vordenberg, Pharm.D., M.P.H., the study’s lead author and a clinical associate professor in the U-M College of Pharmacy.

These appointments look at all the medicines and supplements a person is taking, and look for opportunities to safely reduce dosages, costs and the number of times each day a person must take medication.

Medicare pays for such appointments for enrollees who meet eligibility requirements. But the number of older adults taking advantage of this option, even among those who qualify, as evidenced by data from a 2020 report by the National Poll on Healthy Aging.

Condition-specific preferences

The new study goes beyond the 2023 deprescribing poll report by delving into the conditions the poll respondents said they had.

• 84% of people taking at least one prescription medication said they had some form of cardiovascular condition, which included high blood pressure, and 35% of this group were open to stopping at least one of their cardiovascular medications.
• 29% of respondents taking at least one medication said they had diabetes, and 30% of this group were open to stopping one of their diabetes medications.
• Nearly 50% of the respondents taking prescription medication said they have arthritis, but only 17% of this group were open to stopping a medication for that condition.
• 22% of those taking prescription medication said they had a brain-related condition affecting their mental health or cognition, and 19% of them were open to stopping a medication they take for it.
• 11% of prescription drug users said they had a lung disease such as asthma or chronic obstructive pulmonary disease. Of them, 11% said they would be open to stopping a drug they take for it.

“With guidelines changing for the use of cardiovascular risk-reducing medications as we learn more about who gets the most benefit, it’s important that patients and providers talk openly and regularly about what’s best for their individual circumstances,” says Jeffrey Kullgren, M.D., M.P.H., M.S., an associate professor of internal medicine at Michigan Medicine and physician and researcher at the VA Ann Arbor Healthcare System.

“The same goes for diabetes-related medication, especially with the rise of direct-to-consumer services including for GLP-1 inhibitor medications,” he added. “And with any prescription medication or supplement for any condition, it’s critical for your health care providers to know everything you’re taking, no matter how you’re getting it.”

For more about the poll, which is based at the U-M Institute for Healthcare Policy and Innovation and funded by AARP and Michigan Medicine, U-M’s academic medical center, visit https://www.healthyagingpoll.org/

For more about other deprescribing research by Vordenberg and colleagues, visit https://ihpi.umich.edu/news/why-patients-say-they-want-take-fewer-prescription-meds-wont-when-offered-0

In addition to Vordenberg and Kullgren, the new study’s authors are poll team members Matthias Kirch M.S., Dianne Singer M.P.H., Erica Solway Ph.D., M.S.W., M.P.H., and J. Scott Roberts Ph.D., and Brian J. Zikmund-Fisher Ph.D., of the Center for Behavioral and Social Sciences in Medicine. Roberts and Zikmund-Fisher are faculty in the U-M School of Public Health; they and Vordenberg and Kullgren are members of IHPI.

Citation: Interest in Medication Deprescribing Among US Adults Aged 50–80. J GEN INTERN MED (2024). DOI:10.1007/s11606-024-08945-x