Attitudes Toward Deprescribing Among Older Adults Seeking Care in the Emergency Department

Deprescribing potentially unnecessary or harmful medications may help reduce avoidable emergency department (ED) visits for adverse drug events, which are prevalent among older adults. However, deprescribing in the ED remains rare, in part due to limited evidence on how to implement such practices and an incomplete understanding of patient attitudes in this setting. This study aimed to assess attitudes toward deprescribing among older adults presenting to the ED and explore willingness to accept deprescribing recommendations from emergency clinicians.

We conducted an observational study of adults aged ≥65 years at a single academic ED from June to October 2024. Participants completed the Revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire, which evaluates general willingness to deprescribe and perceived barriers across four domains: medication burden, perceived appropriateness, concerns about stopping, and involvement in decision making. An exploratory question assessed willingness to deprescribe if recommended by ED staff during an ED visit. Descriptive statistics and 95% CIs were calculated.

We enrolled 116 older adults presenting to the ED who completed the rPATD questionnaire. Median patient age was 75 years (IQR 69-80), 72% had multimorbidity, and 56% reported polypharmacy (≥5 medications). Most participants expressed willingness to deprescribe if recommended by their prescriber (91%; 95% CI: 84-95). In contrast, 53% (95% CI: 43-62) expressed reluctance to stop long-standing medications. Most participants reported satisfaction with current medications (87%; 95% CI: 80-92) and a low perceived medication burden, although 28% (95% CI: 21-37) acknowledged possible side effects. Additionally, 87% (95% CI: 80-92%) expressed a desire to be involved in medication-related decisions. Lastly, in an ED-specific exploratory item, 79% of participants (95% CI: 71-86) expressed willingness to deprescribe when recommended by ED staff.

Older adults presenting to the ED are highly receptive to deprescribing, including when recommended by ED staff. These findings support the feasibility of ED-based deprescribing interventions, particularly those that incorporate shared decision making and coordination with outpatient care.