What Makes Families Open to Cutting Medications in Nursing Homes? It’s the Drugs, Not the Demographics

In the crowded world of long-term care, older residents often swallow a small pharmacy every day. The average resident in South Korean long-term care facilities takes more than five medications, and each additional pill carries the risk of side effects, interactions, and a slow erosion of quality of life. Deprescribing — the deliberate, supervised tapering or stopping of medications that may no longer help — has become one of the most important strategies for fighting polypharmacy in aging populations. But deprescribing cannot happen in a vacuum: family caregivers frequently sit at the center of medication decisions for their loved ones, and if families resist the idea of stopping a drug, clinicians may hesitate to suggest it.

A new cross-sectional study published in BMC Geriatrics by Ji-Hye Jung, Woo-young Shin, and Jung-Ha Kim of Chung-Ang University College of Medicine set out to answer a deceptively simple question: what actually shapes family caregivers’ attitudes toward deprescribing? The researchers surveyed 973 family caregivers of residents living in South Korean long-term care facilities, using an online questionnaire and a validated Korean-language instrument called the revised Patients’ Attitudes Towards Deprescribing questionnaire, or K-rPATD. Their findings, published as an open-access research article, offer a data-driven map of when families are most receptive to the conversation about cutting back medications.

The survey population itself tells a story about who makes these decisions. Among the 973 caregivers, 56.0 percent were male and 88.0 percent had a college education or higher — a notably well-educated cohort. Fully 73.0 percent reported that their relatives carried dual-track prescriptions, meaning medications were being managed through more than one prescribing pathway. The residents themselves took an average of 5.6 medications, with a standard deviation of 3.5, and 16.3 percent had experienced at least one adverse drug event, the clinical term for a harmful reaction to a medication.

The K-rPATD breaks attitudes into subscales, and the pattern of scores is revealing. The involvement subscale — how much caregivers want to be part of deprescribing decisions — scored highest at a mean of 3.63 on the instrument’s scale, followed closely by the burden subscale at 3.61, which captures how much caregivers perceive medications as a burden. Concerns about stopping scored 3.33, while the reverse-scored appropriateness subscale, which reflects how necessary caregivers believe current medications to be, had the lowest mean at 2.52. In plain terms: families overwhelmingly want to be involved, they feel the weight of the medication regimen, but they also tend to believe the drugs their relatives take are appropriate and necessary.

Here is where the study’s methodological rigor becomes the real story. The researchers measured 16 potential predictors, represented by 18 regression terms, and entered them simultaneously into multiple linear regression models predicting four subscale scores and two global attitude items. That produced 108 regression coefficients in total. In a large dataset, many coefficients will look statistically significant by chance alone — a phenomenon statisticians call the multiple comparisons problem. To guard against it, the team computed both unadjusted p values and p values adjusted using the Benjamini-Hochberg false discovery rate procedure, a technique that controls the expected proportion of false positives among declared findings. They also used heteroscedasticity-consistent standard errors to keep the estimates robust even when the variability of responses differed across predictor levels.

After this statistical gauntlet, only eight associations survived. Adverse drug events were linked with higher scores on the burden and concerns-about-stopping subscales and lower scores on the appropriateness subscale — an intuitive cluster, since a family that has watched a loved one suffer a medication side effect is more likely to see the drugs as burdensome, more worried about what they do, and less convinced they are all needed. Medication cost was associated with higher burden and concerns-about-stopping scores, suggesting that the financial weight of prescriptions shapes attitudes in parallel with the clinical weight. The number of medications a resident took predicted higher burden scores, and the number of chronic conditions predicted both higher concerns-about-stopping scores and higher involvement scores.

What did not survive the correction is just as telling. Caregivers’ own sociodemographic characteristics — their age, sex, education, and similar attributes — did not emerge as reliable drivers of deprescribing attitudes once the false discovery rate correction was applied. The nominally significant associations that appeared before correction are, the authors emphasize, exploratory only. The message is that attitudes track the resident’s medication-related circumstances, not the caregiver’s background. A family’s willingness to discuss deprescribing is forged by lived experience with the drug regimen: the side effects they have witnessed, the bills they pay, the pill count, and the chronic disease burden their relative carries.

The authors are careful about what this cross-sectional design can and cannot show. Because attitudes and circumstances were measured at the same moment, the study cannot establish causation — it cannot prove, for example, that experiencing an adverse drug event causes caregivers to view medications as more burdensome, only that the two travel together. The findings are described as hypothesis-generating, a scientific term of art meaning they point toward questions that future longitudinal or interventional studies should test. Still, the practical implication is concrete: clinicians who want to raise deprescribing with families now have an evidence-based way to identify the caregivers with whom the conversation is most likely to resonate — those whose relatives have experienced adverse drug events, face high medication costs, take many medications, or manage multiple chronic conditions.

The study was approved by the Institutional Review Board of Chung-Ang University and conducted in accordance with the Declaration of Helsinki, with informed consent from all participants. It was funded by a grant from the Patient-Centered Clinical Research Coordinating Center, funded by South Korea’s Ministry of Health and Welfare, with no funder involvement in design, analysis, or writing. The authors report no competing interests, and they disclosed using AI-assisted tools during manuscript preparation while taking full responsibility for the final content. The complete regression tables, sensitivity analyses, and a completed STROBE reporting checklist are available as supplementary materials, reflecting a transparency standard that makes the statistical machinery — all 108 coefficients, adjusted and unadjusted — open to scrutiny.

For a field where deprescribing conversations often stall at the family’s door, this study reframes the problem. Rather than assuming some caregivers are simply more receptive by temperament or education, the data suggest receptivity is situational, rooted in the concrete realities of the medication regimen itself. That insight could reshape how clinicians approach families in long-term care: instead of a generic pitch for fewer pills, the conversation might begin where the family’s own experience already lives — with the side effect that frightened them, the cost that stings, or the mounting list of prescriptions for a body fighting several chronic diseases at once. In the arithmetic of aging, the study suggests, the path to fewer medications runs through the family’s lived experience of the ones already in the pill organizer.

Subject of Research: Family caregivers' attitudes toward deprescribing medications for older adults in long-term care facilities in South Korea

Article Title: Factors associated with family caregivers’ attitudes toward deprescribing in long-term care facilities: a cross-sectional study in South Korea

Article References: Jung, J.-H., Shin, W.-Y., & Kim, J.-H. (2026). Factors associated with family caregivers’ attitudes toward deprescribing in long-term care facilities: a cross-sectional study in South Korea. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08333-6

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08333-6

Keywords: deprescribing, polypharmacy, family caregivers, long-term care facilities, K-rPATD, adverse drug events, medication cost, geriatrics, South Korea, cross-sectional study, false discovery rate, medication burden