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We aimed to map tasks related to medication management and time consumption in Danish home health care. Nursing staff (n = 30) from five municipalities were followed during a 10‐week period and tasks related to medication management, time consumption and information on citizens' medication were registered. A total of 269 courses were registered, including 163 (61%) home visits, 76 (28%) in‐office courses, 29 (11%) in‐clinic courses and 1 (0.4%) acute visit. Of defined categories related to medication management, 'record‐keeping and communication' (62%, n = 167), 'dispensing' (48%, n = 129) and 'identification' (30%, n = 81) were most often performed. During half of courses (55%, n = 147), the nursing staff was interrupted at least one time. The median time spent on medication management was less than the time allocated in most of allocated time slots (82%), with a median excess time of 5.1 min (range 0.02–24 min). Citizens (n = 32) used a median of 11 (interquartile range [IQR] 9–13) regular medications and 2 (IQR 1–4) as‐needed, and 69% (n = 22) used high‐risk situation medications. In conclusion, employees in Danish home health care perform diverse medication‐related tasks and are frequently interrupted in their work. Employees spend less time than allocated but do not fully solve all tasks according to best practice guidance. [ABSTRACT FROM AUTHOR]

Anticholinergic‐induced cognitive impairment may be partially reversible upon cessation. A barrier to deprescribing of anticholinergics is the unknown risk of anticholinergic adverse drug withdrawal events (ADWE), with only limited information available on the incidence, timing and severity of anticholinergic ADWE. We report the case of a 76‐year‐old woman who experienced significant cognitive improvement following deprescribing long‐term use of a strong anticholinergic drug, doxepin, and dose reduction of another possible anticholinergic agent. The patient decided to abruptly stop taking doxepin, despite a planned careful taper with twice weekly monitoring, but did not experience any severe anticholinergic ADWE and subsequently had significantly improved cognitive function. Future research should focus on better understanding the risk of anticholinergic ADWE so that anticholinergic deprescribing decisions, including how often and by how much to taper, can be made confidently and safely. [ABSTRACT FROM AUTHOR]

Understanding the patient perspective is a significant part of the deprescribing process. This study aimed to explore the attitudes of older patients with psychiatric disorders towards deprescribing. A total of 72 of psychiatric outpatients (68% women; median age 76 years) completed the validated Danish version of the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire. Patients used a median of eight medications (interquartile range 6–12), with 88%, 49% and 24% using antidepressants, antipsychotics and anxiolytics, respectively. Fifty‐one percent of patients reported an intrinsic desire to stop one of their medications, while 92% would be willing to stop one on their physician's advice. Seventy‐five percent of patients would be worried about missing out on future benefits following deprescribing and 37% had previous bad deprescribing experiences. Use of ≥8 regular medications was associated with more concerns about stopping medication and greater perceived burden of using medication, while use of antipsychotics was not associated with any differences in rPATD factor scores. It is crucial for health care professionals to be aware of patients' specific concerns and past experiences to promote a patient‐centred deprescribing approach that takes into account the needs and preferences of older patients with psychiatric disorders. [ABSTRACT FROM AUTHOR]

Deprescribing is the process of reducing or stopping medications when they are unnecessary, have more harm than benefit, or do not align with healthcare goals. The field of deprescribing has grown rapidly in the past decade due to the global problem of medication overuse. The first International Conference on Deprescribing (ICOD) was held in Denmark in September 2022, bringing together 250 participants from around the world. This special issue contains 25 papers that cover a range of topics related to deprescribing, including research, patient/provider communication, knowledge synthesis, deprescribing interventions, patient perspectives, interprofessional collaboration, and real-world deprescribing patterns. The papers aim to inspire and inform further growth and innovation in the field of deprescribing. [Extracted from the article]

Process- and medication-related outcomes are, however, less valuable when testing complex deprescribing interventions targeting multiple medications. Keywords: clinical trial; deprescribing; outcome EN clinical trial deprescribing outcome 3032 3034 3 06/16/22 20220701 NES 220701 Deprescribing, the process of proactively reducing and discontinuing medications,1 is increasingly recognized as an important part of patient care.2-4 This is reflected by markedly expanded research activity within deprescribing, including numerous clinical trials. In this line of reasoning, such reduction is seen as inherently positive as it will translate into less treatment burden and lower medication expenses, while it will not be seen as a loss for the patient or cause any harm as the medications were considered unnecessary at the given time. Effect of antihypertensive medication reduction vs usual care on short-term blood pressure control in patients with hypertension aged 80 years and older: the OPTIMISE Randomized Clinical Trial. [Extracted from the article]

Use of medications of questionable benefit is common in end of life care. In order to effectively carry out deprescribing, it is important to gain insight into the perspectives of patients and their relatives. Thus, our objective was to explore perspectives on deprescribing among older adults with limited life expectancy and their relatives. We conducted semi‐structured interviews with ten nursing home residents and nine relatives. Interviews were analysed using systematic text condensation. Four main themes were identified: "Medication as a necessity and to feel well," "Frailty as a barrier for taking responsibility," "Patient autonomy and faith in authority" and "A wish for being involved." Most participants had not considered the possibility of deprescribing but were open towards medication change if proposed by a healthcare professional. Most participants did not have in‐depth knowledge about medication but would like to be informed or involved in decisions. The participants generally had faith in healthcare professionals despite limited contact. Our study implies that older adults with limited life expectancy and their relatives are generally interested in deprescribing activities; however, the initiative of deprescribing lies with the healthcare professionals. [ABSTRACT FROM AUTHOR]

Background and Objectives Deprescribing may be particularly relevant in older people with limited life expectancy. In order to effectively carry out deprescribing in this population, it is important to understand the perspectives of the full spectrum of health care professionals (HCPs) involved in the management of these patients' medication. Thus, we aimed to explore different HCPs' perspectives on deprescribing in older patients with limited life expectancy. Research Design and Methods Six qualitative focus group interviews were conducted using a semistructured approach. The groups comprised HCPs from both primary and secondary care, including family physicians (FPs), geriatricians, clinical pharmacologists, clinical pharmacists, nurses, and health care assistants. Interviews were audio recorded and transcribed verbatim. Results were analyzed using systematic text condensation. Results A total of 32 HCPs participated in the study (median age of 40.5 years; 22% male). The analysis elicited three main themes related to HCPs' perspectives on deprescribing in older patients with limited life expectancy: (a) Approaching deprescribing, (b) Taking responsibility, and (c) Collaboration across professions. Within themes, subthemes were identified and analyzed. Discussion and Implications Our results imply that different groups of HCPs consider deprescribing an essential aspect of providing good care for older people with limited life expectancy and find that all HCPs play a crucial role in the deprescribing process, with FPs having the primary responsibility. In order to facilitate deprescribing among this population, however, the collaboration between different HCPs should be improved. [ABSTRACT FROM AUTHOR]