title: Factors influencing deprescribing habits among geriatricians.
abstract: BACKGROUND
  deprescribing habits among physicians managing older, frailer, cognitively impaired patients have not been well investigated.
  
  
  METHODS
  an anonymised electronic survey was disseminated to all members of an international geriatric society/local advanced trainee network (N = 930). This comprised a Likert-scale analysis of factors influencing desprescribing, and five case vignettes, detailing a patient with progressive cognitive impairment and dependency, on a background of ischaemic heart disease and hypertension.
  
  
  RESULTS
  among 134 respondents (response rate 14.4%), 47.4% were female, 48.9% aged 36-50 years and 84.1% specialists (15.9% trainees). Respondents commonly rated limited life expectancy (96.2%) and cognitive impairment (84.1%) as very/extremely important to deprescribing practices. On multivariable analysis, older respondents less commonly rated functional dependency (odds ratio [OR] 0.22 per change in age category; P < 0.001) and limited life expectancy (OR 0.09, P = 0.04) important when deprescribing, while female participants (OR 3.03, P < 0.001) and trainees (versus specialists OR 14.29, P < 0.001) more often rated adherence to evidence-based guidelines important. As vignettes described increasing dependency and cognitive impairment, physicians were more likely to stop donepezil, aspirin, atorvastatin and antihypertensives (all P < 0.001 for trend). Aspirin (93.6%) and ramipril (94.1%) were most commonly deprescribed. Commonest reasons cited for deprescribing medications were 'dementia severity', followed by pill burden.
  
  
  CONCLUSIONS
  in this exploratory analysis, geriatricians rated limited life expectancy and cognitive impairment very important in driving deprescribing practices. Geriatricians more often deprescribed multiple medications in the setting of advancing dependency and cognitive impairment, driven by dementia severity and pill burden concerns. Physician characteristics also influence deprescribing practices. Further exploration of factors influencing deprescribing patterns, and patient outcomes, is needed.
authors.affiliation: Department of Geriatric Medicine, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Ní Chróinín
authors.affiliation: Mater Misericordiae University Hospital, Dublin, Ireland.
authors.forename: Chantelle
authors.initials: C
authors.lastname: Ní Chróinín
authors.affiliation: Department of Geriatric Medicine, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Beveridge
mesh_terms: D000328:Adult; D000368:Aged; D003704:Dementia / Q000188:drug therapy*; D000069340:Deprescriptions; D005260:Female; D005853:Geriatrics; D006184:Habits; D006801:Humans; D057970:Inappropriate Prescribing / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000523:psychology*; D019338:Polypharmacy; D011795:Surveys and Questionnaires; D000078329:Workforce
keywords: dementia; geriatrics; inappropriate prescribing; older people; physician's practice patterns; polypharmacy