Barriers and enablers to deprescribing from the perspectives of older adults with polypharmacy and their stakeholders: A systematic review of qualitative studies.

BACKGROUND: The appropriateness of polypharmacy remains debated, with growing concern about the consequences of complex and potentially inappropriate medication use among older adults. Deprescribing is a complex process involving patient and caregiver engagement, clinician-patient communication, and shared decision-making. Understanding barriers and enablers to deprescribing may support shared decision-making and improve the implementation of deprescribing interventions and patient outcomes.

OBJECTIVE: To identify the barriers and enablers influencing deprescribing among older adults with polypharmacy and relevant stakeholders.

DESIGN: This was a systematic review of qualitative studies.

METHODS: Computerized searches were conducted in PubMed, Web of Science, Embase, CINAHL Complete, and PsycInfo. The search scope was limited to articles published from the inception of each database up to December 2025. The Joanna Briggs Institute criteria for qualitative research were utilized to evaluate the quality of the studies, and a thematic synthesis approach was employed to integrate the findings. The Theoretical Domain Framework was used to map barriers and enablers to deprescribing from the perspectives of older adults with polypharmacy and their stakeholders.

RESULTS: A total of 52 studies were included, revealing 18 barriers and 11 enablers across three overarching themes: patient-level factors; physician-patient relationship and communication factors; and healthcare professional-level factors. Attitudes toward medication discontinuation among older adults with polypharmacy are shaped over time by medication-related experiences and interactions with healthcare professionals. The physician-patient relationship can facilitate engagement in deprescribing, whereas inadequate communication may reinforce reliance on long-term medication use. Healthcare professionals also play key roles in initiating and implementing deprescribing. Subthemes were mapped to nine of the 14 domains of the Theoretical Domains Framework, with Social influences, Environmental context and resources, and Beliefs about consequences being the most frequently represented domains.

CONCLUSIONS: This review identified that attitudes toward deprescribing among older adults with polypharmacy are shaped by accumulated medication-related experiences and ongoing interactions with healthcare professionals. Effective physician-patient communication and the active involvement of healthcare professionals are important for facilitating deprescribing, while factors related to healthcare professionals may influence its initiation and implementation. Mapping to the Theoretical Domains Framework identified key behavioral domains that provide a theoretical basis for designing theory-informed interventions to support deprescribing. Together, these findings may inform the development of patient-centred strategies that facilitate safe and effective deprescribing among older adults.

STUDY REGISTRATION: The review protocol was registered in PROSPERO (CRD420251162311).