Investigating the preferences of older adults and their informal caregivers for deprescribing antihypertensive medication in primary care: a DCE

Background Improvements in healthcare mean populations are living longer. Older people have a higher prevalence of chronic illness. Consequently, ‘multimorbidity’ (the coexistence of ≥2 chronic conditions within one individual) is increasingly common and often results in ‘polypharmacy’ (where individuals are prescribed multiple different medications for regular intake) While for many people, all of their medications are necessary, for others, the harm(s) from some of their medication(s) may outweigh the benefits they confer. ‘Deprescribing’ (stopping or reducing) these medications could provide a solution to this potentially inappropriate polypharmacy. Antihypertensives are one of the most commonly prescribed drug classes in older adults. In England, over half of people aged 65+ years are prescribed at least one antihypertensive. These medications provide benefits such as a reduced risk of stroke and heart attack. However, they also have some potential drawbacks including increased risk of serious falls and side effects. Medication-related decisions are typically made between healthcare professionals and patients. However, information caregivers – defined as ‘individuals who have any role in a family member or friend’s health management and/or medication management’ – may also play a role particularly in older populations.

Despite their involvement, little is known about the antihypertensive deprescribing preferences of older adults and their informal caregivers and which factors they prioritise in these decisions. This survey study therefore aims to address this research gap. Understanding these preferences is essential for supporting shared decision-making, improving patient-centred care, and reducing inappropriate medication use in ageing populations. Method A survey has been designed containing discrete choice tasks. This has been distributed to eligible older adults and informal caregivers. Participants were asked to make choices between continuing with their antihypertensive medications or reducing them, depending on the level of risk presented in each task. The following research questions will be addressed:

1. Which attributes influence the willingness of patients and informal caregivers to deprescribe antihypertensive med?

2. Which attribute do patients and informal caregivers prioritise when making antihypertensive medication deprescribing decisions?

3. What trade-offs are patients and informal caregivers willing to make between clinical benefits and clinical risks when considering deprescribing antihypertensives?

4. Which (if any) patients and informal caregivers characteristics influence the extent to which they are affected by change in specific attributes when deciding whether to deprescribe antihypertensive med?