Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review

Barriers and Enablers for Deprescribing Glucose-Lowering Treatment in Older Adults: A Systematic Review

Overtreatment with glucose-lowering treatment (GLT) is frequent and a source of high morbidity and mortality in older adults with type 2 diabetes mellitus (T2DM). This study aimed to identify and synthesize barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. Systematic...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American Medical Directors Association Vol. 25; no. 3; pp. 439 - 447.e18
Main Authors: Mellot, Marion, Jawal, Lina, Morel, Thomas, Fournier, Jean-Pascal, Tubach, Florence, Cadwallader, Jean-Sébastien, Christiaens, Antoine, Zerah, Lorène
Format: Journal Article
Language:English
Published: United States Elsevier Inc 01-03-2024
Elsevier
Subjects:
Behavior
deprescription
geriatrics
Human health and pathology
hypoglycemic agents
Life Sciences
qualitative research
deprescription
geriatrics
Behavior
qualitative research
hypoglycemic agents
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Overtreatment with glucose-lowering treatment (GLT) is frequent and a source of high morbidity and mortality in older adults with type 2 diabetes mellitus (T2DM). This study aimed to identify and synthesize barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. Systematic review of qualitative and mixed-methods studies. Older adults with T2DM, any participants [patients, health care providers (HCPs), caregivers], any settings. Two researchers (and a referred third researcher at all stages) independently screened original articles reporting qualitative and mixed-methods studies exploring barriers and enablers for deprescribing GLT in older adults published during 2010-2023, identified from MEDLINE, Embase, CINAHL, and gray literature. Quality of the included studies was assessed with the Mixed-Methods Appraisal Tool. Verbatim statements on barriers and enablers were extracted, and determinants of behaviors were identified with the Theoretical Domains Framework (TDF) version 2, and related intervention functions (targets for future interventions) were proposed according to the Behavior Change Wheel (BCW). We identified only 4 studies from 2 countries (United States and the Netherlands), all recently published (2019-2023), that primarily reported barriers to GLT deprescribing from interviews or focus groups of patients or HCPs practicing outpatient medicine. Knowledge, fear, poor communication, inertia, and trust with HCPs were the main determinants of behaviors that influenced deprescribing, and education, training, persuasion and environmental restructuring were the main intervention functions for proposing future interventions. Studies did not cover financial aspects, physician characteristics, or caregiver and family viewpoints. The use of a behavioral theory and a validated implementation framework provided a comprehensive approach to identifying barriers and enablers for deprescribing GLT in older adults (≥65 years) with T2DM. The behavioral determinants identified may be useful in tailoring interventions to improve the implementation of GLT deprescribing in older adults in ambulatory settings.
Bibliography:ObjectType-Article-2
SourceType-Scholarly Journals-1
ObjectType-Feature-3
content type line 23
ObjectType-Review-1
ObjectType-Undefined-4
ISSN:1525-8610
1538-9375
DOI:10.1016/j.jamda.2023.11.025