A Multimethod Approach To Identify Factors And Improve The Process Of Deprescribing Anticholinergics In Older Adults.

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dc.contributor.advisorCampbell, Noll
dc.contributor.authorAlamer, Khalid Ahmed A
dc.date.accessioned2023-05-31T10:57:26Z
dc.date.available2023-05-31T10:57:26Z
dc.date.issued2023-04-28
dc.description.abstractPolypharmacy in older adults presents several challenges, such as suboptimal therapeutic outcomes and increased adverse effects. Deprescribing, a clinically supervised process of decreasing dosage or stopping the medication when risks outweigh benefits, has emerged as one possible solution to these problems. However, the literature describing deprescribing intervention frameworks is heterogenous regarding targeted medications to deprescribe, population characteristics, clinical settings, and measured outcomes. This dissertation utilizes Linsky et al.'s deprescribing conceptual model, which details factors influencing decisions regarding initiating deprescribing interventions and their direct impact on the process. This dissertation utilizes a multimethod approach to investigate factors that facilitate and improve the deprescribing of anticholinergic medications for older adults, addressing gaps in this population's anticholinergic medication use. The three studies included in this dissertation provide a comprehensive understanding of deprescribing anticholinergic medications for this population, each contributing unique insights and results. The first study explores the feasibility of in-person and remote Home Medication Inventory Method (HMIM) approaches to evaluate over-the-counter (OTC) and prescription medication possession and use, including anticholinergics. Results demonstrate that both methods can accurately assess anticholinergic medication usage patterns, providing healthcare providers with reproducible methods and detailed medication profiles to make informed deprescribing decisions based on complete medication lists. The second study examined the intertwined roles of social determinants of health and health beliefs in predicting older adults' self-reported deprescribing behaviors, proposing the Deprescribing Health Belief Model (DeRx-HBM) framework that can be utilized for these efforts. These results emphasize the importance of considering these elements when creating a patient-centric and culturally sensitive intervention since they significantly shape deprescribing behaviors. In the third study, we explored the use of a symptom-specific scale for measuring the symptom burden in older adults during the deprescribing of anticholinergic medications prescribed for urinary incontinence, depression, and pain management. This research introduces a validated scale for assessing anticholinergic symptom burden prior to, throughout, and following the deprescribing attempt. The implementation of this scale has the potential to enhance the reproducibility and standardization of deprescribing decisions. Furthermore, it can improve communication between healthcare professionals and patients, as well as monitor the effectiveness of interventions during and after the deprescribing process. Collectively, these studies provide invaluable insights into factors influencing deprescribing decisions, obstacles to implementing deprescribing practices, and potential strategies to optimize medication management in older adults. The major takeaway from these studies is that addressing these factors leads to more informed decisions among healthcare professionals and patients - potentially leading to improved patient outcomes, ensure the ongoing effectiveness of deprescribing initiatives among older adults, and the promotion of health equity throughout the deprescribing process.
dc.format.extent120
dc.identifier.urihttps://hdl.handle.net/20.500.14154/68229
dc.language.isoen_US
dc.publisherHammerRR
dc.subjectDeprescribing
dc.subjectOlder Adults
dc.subjectDeprescribing Health Belief Model
dc.subjectAnticholinergic Cognitive Burden
dc.subjectSocial Determinants of Health
dc.subjectHome Medication Inventory Method
dc.titleA Multimethod Approach To Identify Factors And Improve The Process Of Deprescribing Anticholinergics In Older Adults.
dc.typeThesis
sdl.degree.departmentPharmacy Practice
sdl.degree.disciplinePharmacy Practice
sdl.degree.grantorPurdue University
sdl.degree.nameDoctor Of Philosophy
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