Deprescribing for People with Dementia: A Roadmap

Area of Science:

• Geriatrics
• Pharmacology
• Neurology

Background:

• People with dementia (PWD) often face polypharmacy and potentially inappropriate medication (PIM) use, increasing risks.
• Medication risks can outweigh benefits or misalign with treatment goals in PWD.
• Appropriate deprescribing is vital for high-quality dementia care, preventing harm and enhancing well-being for patients and care partners.

Purpose of the Study:

• To review the risks of polypharmacy in PWD.
• To examine the evidence for deprescribing safety and efficacy in this population.
• To provide a practical roadmap for deprescribing in PWD, addressing unique dementia-related challenges.

Main Methods:

• Review of existing deprescribing frameworks for older adults.
• Adaptation of frameworks to address dementia-specific issues like disease variability and behavioral symptoms.
• Development of a step-by-step roadmap for deprescribing in PWD.
• Inclusion of communication strategies for patients and care partners.

Main Results:

• Polypharmacy poses significant risks to people with dementia.
• Deprescribing can be safe and effective in PWD when implemented systematically.
• A structured approach to deprescribing, including goal elicitation, tapering plans, and follow-up, is proposed.
• Communication strategies are adapted to facilitate shared decision-making.

Conclusions:

• Deprescribing is an essential component of high-quality dementia care.
• The proposed roadmap provides a structured approach to medication withdrawal in PWD.
• Effective communication with patients and care partners is key to successful deprescribing.
• This approach aims to improve health outcomes and reduce iatrogenic harm in PWD.