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Development of a structured deprescribing intervention for people with dementia or mild cognitive impairment in primary care (STOP-DEM)

Team:

Kinda Ibrahim is a lecturer and a pharmacist at the Faculty of Medicine and the Deputy Lead for the Ageing and Dementia Theme within the NIHR ARC Wessex

Jay Amin is Associate Professor in Psychiatry of Older Age at the University of Southampton and an honorary consultant in Old Age Psychiatry at Southern Health NHS Foundation Trust.

Sue Latter is a Professor of Health Services Research and a nurse by background and an expert in medicines optimisation research.

Simon Fraser is an Associate Professor in Public Health at the University of Southampton.

Ruth Bartlett is a Professor at the University of Southampton and Director of the University of Southampton's Doctoral Training Centre in Dementia Care, and a lead coordinator for the ARC Wessex Faculty. 

Rosemary Lim is an Associate Professor at school of pharmacy, University of Reading.

Michelle Board is an Associate Professor in Nursing Older People at the Faculty of Health and Social Science at Bournemouth University.

Starts: October 2022

Ends: September 2024

Lay Summary
Most people with dementia or mild cognitive impairment (MCI) have multiple chronic conditions and take five or more regular medications (polypharmacy). Polypharmacy in people with dementia/MCI can lead to increased risk of drug interactions, side effects such as falls and cognitive decline, and sometimes hospitalisation and death. Some types of medications (such as strong anticholinergic drugs) can increase risk of developing dementia and cognitive impairment. It is estimated that over £400 million is spent annually in the UK in hospital admissions related to harm from medications. Identifying harmful medications and stopping or switching to safer alternative (deprescribing) has the potential to reduce the risk of developing dementia and improve outcomes for people already living with dementia.

However, to date, deprescribing interventions for people with dementia/MCI have focused on specific drug classes (e.g., anti-psychotics) or have been limited to inpatient or nursing home setting. In the UK, it is estimated that 61% of people with dementia live at home where medication is a part of daily living. Most studies also focused on medication-related outcomes (e.g. discontinuation of high-risk medications) rather than patient-centred outcomes, and did not involve the person with dementia and their carer. Therefor it is essential to understand how primary care staff could involve people with dementia/MCI and their caregivers in shared-decision making about stopping medications safely.

The aim of this study is to develop a primary care–based deprescribing intervention focusing on increasing shared-decision making targeting people with dementia/MCI and their caregivers. The proposed research will include two phases:

First, a search of published literature to understand how effective deprescribing interventions among people with dementia/MCI, with a focus on what works or does not work for this population.

Secondly, we will conduct interviews with people with dementia/MCI and their caregivers as well as healthcare professional. We want to understand how deprescribing can be initiated and monitored among people with dementia or MCI in primary care setting and how patients and their caregivers could be involved in decisions about medication taking.

Then we will use the information we gather to identify the key elements/factors that make deprescribing and shared-decision making possible in primary care. We will develop an intervention which will then be refined in a future study, subject to funding, through a series of workshops and rapid iterations with key stakeholders to discuss its content, format, style and delivery.