PURPOSE: To provide an overview of the current deprescribing attitudes, practices, and approaches of geriatricians and geriatricians-in-training across Europe. METHODS: An online survey was disseminated among European geriatricians and geriatricians-in-training. The survey comprised Likert scale and multiple-choice questions on deprescribing approaches and practices, deprescribing education and knowledge, and facilitators/barriers of deprescribing. Responses to the survey questions and participant characteristics were quantified and differences evaluated between geriatricians and geriatricians-in-training and between European regions. RESULTS: The 964 respondents (median age 42 years old; 64% female; 21% geriatricians-in-training) were generally willing to deprescribe (98%) and felt confident about deprescribing (85%). Despite differences across European regions, the most commonly reported reasons for deprescribing were functional impairment and occurrence of adverse drug reactions. The most important barriers for deprescribing were patients' unwillingness, fear of negative consequences, lack of time, and poor communication between multiple prescribers. Perceived risk of adverse drug reactions was highest for psychotropic drugs, nonsteroidal anti-inflammatory drugs, cardiovascular drugs, and opioid analgesics. Only one in four respondents (23% of geriatricians and 37% of geriatricians-in-training) think education in medical school had sufficiently prepared them for deprescribing in clinical practice. They reported that their future deprescribing activities would probably increase with improved information sharing between various prescribers, deprescribing recommendations in guidelines, and increased education and training. Approximately 90% think that a paradigm shift is required for prescribers and patients, increasing focus on the possible benefits of deprescribing (potentially) inappropriate medications. CONCLUSIONS: Based on the outcomes of this survey, we recommend investing in improved inter-professional communication, better education and evidence-based recommendations to improve future patient-centered deprescribing practices.

Amsterdam Public Health Research Institute Aging and Later Life Amsterdam The Netherlands

Center for Appropriate Medication Use Sheba Medical Center and Deputy Head Homecare Hospice Israel Cancer Association 55 Ben Gurion Road 5932210 Bat Yam Israel

Clinical Pharmacology Mannheim Medical Faculty Mannheim Heidelberg University Mannheim Germany

Cooperatio 34 Internal Disciplines 3rd Faculty of Medicine Charles University Prague Czech Republic

Department of Cardiovascular Endocrine Metabolic Diseases and Aging Istituto Superiore di Sanità Rome Italy

Department of Elderly Care Medicine Amsterdam University Medical Centers Location Vrije Universiteit Amsterdam De Boelelaan 1117 Amsterdam Netherlands

Department of Geriatric Medicine Odense University Hospital Odense Denmark

Department of Internal Medicine Hospital Curry Cabral Centro Hospitalar Universitário de Lisboa Central Lisbon Portugal

Department of Internal Medicine Section of Geriatrics Amsterdam University Medical Centers Location University of Amsterdam Meibergdreef 9 Amsterdam The Netherlands

Department of Medical Gerontology Trinity College Dublin Dublin Ireland

Division of Geriatrics Department of Internal Medicine Istanbul Medical School Istanbul University Capa Istanbul Turkey

Division of Geriatrics Department of Internal Medicine Sisli Hamidiye Etfal Training and Research Hospital University of Medical Sciences Istanbul Turkey

Effective Prescribing and Therapeutics Health and Social Care Directorate Scottish Government Edinburgh Scotland UK

Faculty of Medicine University of Iceland Reykjavik Iceland

Geriatric Research Unit Department of Clinical Research University of Southern Denmark Odense Denmark

Geriatrics Unit Department of Palliative Medicine Poznan University of Medical Sciences Poznan Poland

Graduate School of Communication Science University of Amsterdam Amsterdam The Netherlands

Hellenic Open University Patras Greece

Landspitali University Hospital Reykjavik Iceland

Mercers Institute of Successful Ageing St James's Hospital Dublin Ireland

Odense Deprescribing Initiative Odense University Hospital and University of Southern Denmark Odense Denmark

Outpatient Geriatric Assessment Unit Henry Dunant Hospital Center Athens Greece

School of Pharmacy University of Eastern Finland Kuopio Finland

Section of Geriatrics Department of Internal Medicine and Paediatrics Ghent University Ghent Belgium

Servicio de Geriatría Hospital Universitario Ramón y Cajal IRYCIS Madrid Spain

Université de Lorraine CHRU Nancy Pôle Nancy France

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