Deprescribing-the safe and effective cessation of medications likely to cause more harm than benefit-is recommended to reduce falls and other adverse effects in older adults. Health care practitioners, however, often encounter barriers to deprescribing at multiple levels, including systemically and among clinicians and patients. Researchers conducted a study to explore patient and clinician experiences and perceptions of deprescribing potentially inappropriate medications in patients with a history of falls.

Study participants included primary care physicians from a large, integrated health care system whose patients had a history of falls and members of a patient advisory committee. Most members of the advisory committee were at or above retirement age and, the researchers hypothesized, would have likely experienced a fall or had a family member with this experience. The researchers conducted semistructured interviews with the physicians and held facilitated discussions with patients that included mock fall scenarios.

Physicians were aware of deprescribing recommendations, but the researchers found that perception of their value was mixed. Physicians had concerns about potentially contentious discussions with patients, expressed varying levels of comfort with deprescribing strategies, and said patients are often resistant to deprescribing, even after a fall. Some suggested that these conversations might be better left to others, such as nurses or pharmacists. Physicians also perceived that patients might hide or minimize falls and fear their loss of independence when faced with deprescribing. They also voiced concern that patients might seek another provider if medications were discontinued. Patients lacked clarity about the seriousness of falls in older adults and the connection between medications and falls. They were also concerned about the effect of deprescribing on quality of life.

The authors note that their physician sample included only primary care physicians and that the study was conducted in a highly integrated health care system, so their findings may not be generalizable to other types of physicians or health care systems.