Tools for deprescribing in severe dementia: A scoping review

• Published in: International journal of geriatric psychiatry 2023-07, Vol.38 (7), p.e5959-n/a
• Main Authors: Wang, Christina, Roberts, Eliot, Smith, Greg, Carland, Jane E., Cordato, Nicholas J.
• Format: Article
• Language: English
• Subjects: Adverse events; Clinical outcomes; Cognitive ability; Dementia; Dementia - drug therapy; Dementia disorders; deprescribing; Deprescriptions; Geriatric psychiatry; Humans; medication withdrawal; Quality of Life; scoping review; severe dementia
• ISSN: 0885-6230; 1099-1166
• DOI: 10.1002/gps.5959

Objectives Identification of inappropriate medications in people living with severe dementia is a complex task which has the potential to reduce avoidable adverse events and increase quality of life. This scoping review (i) identifies published tools intended to aid deprescribing in people living with severe dementia and (ii) describes evaluations of their usefulness in clinical practice. Methods A scoping review was undertaken, with Medline, Medline in Process, EMBASE, Cochrane Library, CINAHL, Scopus and Web of Science databases, from inception to April 2023, identifying tools for deprescribing in severe dementia. A tool was considered as any resource for deprescribing, including clinical study, scientific publication, health guideline, website, algorithm, model or framework. Two reviewers assessed the eligibility of articles through and full text review. Data extracted from included studies were summarized through narrative synthesis. Results Twelve studies were identified from 18,633 articles screened. Tools were categorized into three groups: deprescribing interventions (n = 2), consensus‐based deprescribing criteria (n = 5), and medication‐specific recommendations (n = 5). Six studies developed tools using expert opinion and ten tools were tested in people living with severe dementia. Only one of the four studies that evaluated patient outcomes (cognitive change and adverse events) identified clear clinical benefit from medication withdrawal. Conclusions Clinical application of current deprescribing tools is limited due to the lack of evidence‐based research on the clinical effects of individual medication deprescribing in people with severe dementia. Further research on patient outcomes, including cognitive change and adverse events, will help clarify the role of these tools in clinical care. Key points Twelve studies were identified describing deprescribing tools for use in people living with severe dementia. Few tools provided evidence‐based recommendations, with many tools designed through expert opinion. Most tools tested in study populations that observed patient outcomes could not conclude clear clinical benefit from medication withdrawals.