The role of older adult functional, interactive and critical health literacy in deprescribing

Background Health literacy capability is thought to increase participation in shared decision-making, subsequently contributing to successful deprescribing or medication discontinuation. Deprescribing often requires complex decision-making processes where real or potential benefits and harms are considered alongside treatment preferences, attitudes, assumptions and beliefs about medication use. During this process, older adults may utilise health literacy skills to gather, evaluate, reflect on and apply information to their contexts and to effectively communicate their treatment preferences.Aims This study explores older adults’ reports of their use of different types of health literacy skills (functional, interactive and critical) when making decisions about reducing or stopping their medicines. We seek to explain what influence, if any, health literacy has on their willingness to participate in making decisions about deprescribing.Methods We conducted a secondary qualitative analysis of interview data from 25 older adults taking five or more medications in Australian primary care settings. The previously transcribed and coded interviews were re-examined using NVivo 12 software, applying Nutbeam’s health literacy framework to guide the analysis.Results All participants used functional health literacy in the day to day management of their medications. However, some described knowledge gaps in their understanding of their medicines, the benefits of deprescribing and who is responsible to deprescribe. Interactive health literacy skills were used to question health care providers. Some expressed their general deprescribing preferences or applied medication information to request specific medications be discontinued. Fewer participants mentioned the use of critical health literacy, which is noteworthy as this capability facilitates empowerment and is likely to influence participation in shared decision-making.Discussion We recommend changes in primary care practice to promote opportunities for older adults to develop and apply health literacy skills. Additional medicine and deprescribing information should be provided, regardless of older adult preferences for involvement in decision making. Deprescribing trials may provide opportunities to build experiential knowledge. Information about who is responsible for deprescribing is required to enable older adults to navigate health services. Improved health literacy, especially critical health literacy, may modify preferences for involvement in shared decision-making regarding deprescribing.