Towards safer medication use in older adults: Investigating barriers and facilitators of deprescribing

Aims: Deprescribing, the process of stopping unnecessary medications, is essential for optimizing pharmacotherapy in older adults but is hindered by systemic, knowledge and patient-related barriers. This study explored physicians' perspectives on barriers and facilitators to deprescribing in older adults using the Theoretical Domains Framework (TDF), in an LMIC setting with limited evidence. Methods: A qualitative study was conducted using in-depth interviews with physicians (n = 52) to explore barriers, facilitators and potential improvements in deprescribing practices. Thematic analysis was applied to identify key insights and patterns from the collected data. Results: This study identified several barriers to deprescribing, including limited healthcare access in rural areas and knowledge gaps in geriatric pharmacology among resident doctors. Patient-specific challenges, such as advanced age and multiple comorbidities, further complicated the process. The chronic use of medications like proton pump inhibitors (PPIs) and benzodiazepines was also a prominent barrier. Systemic and logistical issues, such as inefficient workflows and poor interdisciplinary coordination, were noted as critical impediments. Key facilitators included patient acceptance, which was pivotal for adherence and outcomes, and the active participation of educated patients in shared decision-making processes. A growing acceptance of deprescribing among doctors, especially in government healthcare, was observed, with effective communication key to overcoming patient resistance and building trust. Conclusion: Overcoming systemic barriers, enhancing patient education and implementing structured guidelines are key to improving deprescribing. Interdisciplinary collaboration and digital tools like electronic health records can further ensure safe medication discontinuation. Targeted interventions are essential to optimizing deprescribing and improving older adult's health outcomes.