Affiliation:
1. The University of New South Wales Faculty of Medicine Sydney New South Wales Australia
2. Department of Pharmacology School of Medical Sciences University of New South Wales Sydney New South Wales Australia
3. Department of Clinical Pharmacology and Toxicology St. Vincent's Hospital Sydney New South Wales Australia
4. School of Clinical Medicine University of New South Wales Medicine & Health St Vincent's Healthcare Clinical Campus Faculty of Medicine and Health University of New South Wales Sydney New South Wales Australia
5. University of New South Wales School of Clinical Medicine St George and Sutherland Clinical Campuses Sydney New South Wales Australia
6. The Department of Aged Care St George Hospital Kogarah New South Wales Australia
7. Calvary Health Care Sydney Kogarah New South Wales Australia
Abstract
AbstractObjectivesIdentification 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.MethodsA 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 abstract and full text review. Data extracted from included studies were summarized through narrative synthesis.ResultsTwelve 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.ConclusionsClinical 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.
Subject
Psychiatry and Mental health,Geriatrics and Gerontology