A qualitative study on the challenges in deprescribing for elderly patients with polypharmacy

Background Deprescribing is a critical strategy for optimizing medication use in older adults with polypharmacy, yet its implementation in real-world clinical settings faces multifaceted challenges that require systematic understanding. This study aims to explore these barriers to inform effective service integration. Objectives To gain an in-depth understanding of the challenges of deprescribing in elderly patients with polypharmacy and to inform the implementation of deprescribing services in healthcare institutions. Methods Purposive sampling was utilized to carry out semi-structured in-depth interviews with key stakeholders involved in deprescribing, namely patients, physicians, pharmacists, and nurses. The data were coded, and themes were identified via the implementation of phenomenological analysis and Colaizzi’s seven-step method. Results A total of four themes and 11 sub-themes were identified, namely clinical challenges (characterized by the complexity of managing multiple chronic conditions, the complexity of medication regimens, clinical workload, and time constraints), collaborative challenges (manifested as disruptions in interdisciplinary healthcare collaboration and a lack of trust between physicians and patients), concerns regarding medical risks (including uncertainty of treatment efficacy, safety concerns, ambiguity in responsibility and authority, decision-making inertia, and preference for the status quo), and institutional barriers (evidenced by a lack of specialized training and continuing education programs and misaligned incentive structures). Conclusion Deprescribing for elderly patients with polypharmacy encounters numerous challenges, such as clinical intricacies, communication obstacles, apprehensions about medical risks, and institutional constraints. To facilitate the implementation of deprescribing for elderly patients with polypharmacy, a holistic reform is necessary, which involves workflow enhancement, interprofessional communication and cooperation, patient - provider interaction, and supportive systems and training initiatives. Only by clearly acknowledging the value of this work, standardizing procedures, minimizing hazards, and institutionalizing incentive mechanisms can we surmount the current barriers and allow more elderly patients to reap the benefits of safe and rational medication use and attain a peaceful and dignified aging process.