Behavioral determinants of deprescribing among older adults in French-speaking Belgium

Abstract Background Inappropriate polypharmacy is a major public health challenge. Understanding the behavioral determinants (BD) of older people's willingness to engage in deprescribing can enhance medication optimization. However, current research on deprescribing focuses primarily on attitudes. This study aims to examine the behavioral factors that are associated with the intention to engage in deprescribing and deprescribing behavior. In addition, it examined the role of health literacy (HL) as a possible moderator. Methods A self-administered survey was conducted among patients aged ≥60 years who demonstrated polypharmacy (≥5 chronic medications), recruited from the Belgium French-speaking population. Of 139 participants, 65% were ≥75 years, 68% were female, and 74% reported polypharmacy. Measures included the 25-item Behavioral Determinants of Deprescribing Questionnaire (BDDQ) and the 12-item Health Literacy Survey Questionnaire (HLS-Q12). Multivariable logistic regression analysis was applied to assess the impact of BD, HL and past behavior on the patient's intention to deprescribe. Results A large majority of respondents (66.4%) had low HL; 22.6% were in the process of deprescribing, and 57% were willing to deprescribe with GP support. Determinants associated with deprescribing intention were perceived deprescribing effects (odds ratio (OR) 0.40; 95% confidence interval [0.19; 0.83]), perceived medication risks (OR 1.85 [1.04; 3.30]). Previous deprescribing behavior (OR 4.12 [1.32; 12.86]) and perception of medication risks (OR 1.42 [1.006; 1.99]) were the only two statistically significant predictors of deprescribing behavior. Conclusions Most older adults are willing to deprescribing with GP support. GP-led educational interventions adapted to the patients’ HL level, which combine information sharing with an understanding of patients’ perceptions with regard to deprescribing, can further improve deprescribing. Key messages • Inappropriate polypharmacy is a major public health problem, particularly in people over 60 years. • A thorough understanding of the factors influencing older adults’ deprescribing decisions is crucial for the effective implementation of deprescribing interventions.