Perspectives on deprescribing in older people with type 2 diabetes and/or cardiovascular conditions: challenges from healthcare provider, patient and caregiver perspective and interventions to support a proactive approach

ABSTRACT

Introduction

For people with type 2 diabetes and/or cardiovascular conditions, deprescribing of glucose-lowering, blood pressure-lowering and/or lipid-lowering medication is recommended when they age, and their health status deteriorates. So far, deprescribing rates of these so-called cardiometabolic medications are low. A review of challenges and interventions addressing these challenges in this population is pertinent.

Areas covered

We first provide an overview of relevant deprescribing recommendations. Next, we review challenges for healthcare providers (HCPs) to deprescribe cardiometabolic medication and provide insight in the patient and caregiver perspective on deprescribing. We summarize findings from research on implementing deprescribing of cardiometabolic medication and reflect on strategies to enhance deprescribing. We have used a combination of methods to search for relevant articles.

Expert opinion

There is a need for rigorous development and evaluation of intervention strategies aimed at proactive deprescribing of cardiometabolic medication. To address challenges at different levels, these should be multifaceted interventions. All stakeholders must become aware of the relevance of deintensifying medication in this population. Education and training for HCPs and patients should support patient-centered communication and shared decision-making. Development of procedures and tools to select eligible patients and conduct targeted medication reviews are important for implementation of deprescribing in routine care.

KEYWORDS:

• Cardiometabolic risk factors
• deprescribing
• deprescriptions
• diabetes mellitus type 2
• implementation science
• medication review
• older adults
• patient-centered care
• shared decision making

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Declaration of interest

P Stuijt declares that his research on deprescribing is funded by the Dutch organization ZonMw (project number 10140022010002, as part of the program ‘Goed Gebruik Geneesmiddelen’). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Article highlights

• The idea that cardiometabolic medication must be used for the rest of one’s life should change to the idea that continuation of such medication should be reconsidered with ageing.

• Proactive deprescribing of cardiometabolic medication among older people is limited and can be increased with implementation strategies.

• Challenges perceived by healthcare providers, patients and caregivers are to be addressed at system, organizational, interpersonal, and individual level.

• Deprescribing of cardiometabolic medication involves decisions under uncertainty for which training and tools to support patient-centered communication and shared decision-making are required.

• Intervention strategies should pay attention to adoption, implementation and maintenance of changes in deprescribing for all stakeholders.

• Research on developing cost-effective intervention strategies to support deprescribing of cardiometabolic medication in clinical practice workflows is pertinent.

Additional information

Funding

This paper was not funded.