| dc.description.abstract | Background - Falls in older adults are a common problem with major consequences. The use of fall-risk- increasing drugs (FRIDs) is one of the risk factors and deprescribing could therefore, hypothetically, reduce the risk of falls in older adults. Based on previous qualitative studies, shared decision-making (SDM) appears to be important in order to obtain effective deprescribing. However, this association has not yet been established using quantitative data. Therefore, this quantitative study aimed to investigate the influence of patient-reported SDM on the deprescribing of FRIDs in older adults. In addition, we were interested to see whether this effect differed between patients with and without polypharmacy.
Methods - A prospective cohort study was conducted using data from 31 patients visiting the falls or geriatric clinic of the Academic Medical Center of Amsterdam (AMC). To measure the degree of SDM, the iSHAREpatient questionnaire was used. Deprescribing was identified by using the letter corresponding to the consultation at the falls clinic which was stored in the medical software application of the hospital. Binary logistic regression, adjusted for age, gender and satisfaction with physician, was conducted to investigate the association between the mean patient-reported SDM score and deprescribing. In addition, an interaction term was created to analyze the potential moderator effect of polypharmacy.
Results - Binary logistic regression showed a significant association between overall patient-reported SDM and deprescribing (adjusted odds ratio (aOR) 3.04 [95% confidence interval (CI) 1.05-8.75]). Of the six dimensions of the iSHAREpatient questionnaire, choice awareness and deliberation also showed significant associations with deprescribing (aOR 2.16 [95% CI 1.04-4.46] and 2.44 [95% CI 1.05-5.70]; respectively). These associations did not significantly differ between patients with and without polypharmacy (P-value >0.1).
Conclusion - This study showed a significant association between higher mean patient-reported SDM scores and the possibility to deprescribe. Since this was the first quantitative study investigating this association with a relatively small study population, further research needs to establish these findings and their clinical relevance on, eventually, decreasing the risk of falls in older adults. | |
