Managing multiple medications becomes increasingly complex as adults age, yet reducing unnecessary prescriptions remains challenging despite clear health benefits. Understanding why patients resist medication reduction could unlock safer, more targeted treatment approaches for millions of older adults navigating polypharmacy.
This comprehensive analysis of 37 studies involving older adults identified four primary barriers preventing successful deprescribing: patients' belief in medication appropriateness, concerns about the deprescribing process itself, social and contextual pressures, and deep-seated fears about stopping treatments. The research revealed that perceived medication burden emerged as a key facilitator, suggesting patients become more receptive to reduction when they experience tangible negative effects from their current regimen.
These findings illuminate a critical gap in geriatric care delivery. While healthcare providers increasingly recognize polypharmacy risks—including falls, cognitive impairment, and dangerous drug interactions—patient psychology often conflicts with clinical recommendations. The research suggests successful deprescribing requires addressing emotional and social factors alongside medical considerations. Fear-based resistance appears particularly powerful, with patients worrying about symptom return or disease progression even when medications provide minimal benefit. This represents a significant shift from viewing medication reduction as purely clinical to understanding it as a complex behavioral intervention requiring patient partnership and trust-building over time.