Barriers and facilitators to deprescribing in older adults: an integrative review

Background/Purpose: Polypharmacy and the use of potentially inappropriate medications are increasing among older adults. Deprescribing represents a potential solution to optimize medication regimens and align treatment with patient preferences. This integrative review aimed to identify older adults’ barriers and facilitators to deprescribing and to integrate qualitative and quantitative evidence to provide a comprehensive understanding of these factors. Methods: We conducted an integrative review following Whittemore and Knafl’s five-step framework. We performed a search in MEDLINE, Embase, CINAHL, and Scopus for studies published between 2020 and 2025. We included qualitative, quantitative, and mixed-method studies involving adults aged 65 years or older that explored perceptions of deprescribing. Data were extracted and each study was critically appraised using the CASP checklists. Findings from qualitative and quantitative studies were then integrated using joint displays to identify areas of convergence, complementarity, and divergence. Results: The review included 37 studies (24 quantitative and 13 qualitative). Four themes describing barriers to deprescribing were identified: perceived appropriateness of medications, the deprescribing process, social and contextual influences, and concerns and fears related to stopping medication. Facilitators overlapped with the first three themes and included an additional theme related to the perceived burden of medication use. Key barriers included perceived necessity of medications, fragmented medical care and limited patient knowledge about medications. Key facilitators included shared decision-making with healthcare professionals, trust in healthcare professionals, and adequate monitoring or follow-up. The integration of findings revealed both convergence, such as the importance of trust, and divergence, with quantitative studies suggesting higher levels of medication knowledge than those reported in the qualitative findings. Conclusions: These findings highlight that older adults’ willingness to deprescribe is strongly influenced by trust in healthcare professionals, shared decision-making, and the availability of appropriate monitoring and follow-up. Addressing these factors may support more effective medication review and deprescribing discussions in clinical practice. The results also suggest that improving coordination of care and involving patients and caregivers in medication-related decisions may help address barriers to deprescribing in older adults.