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

Nicola Andrews, Research Fellow, NIHR ARC Wessex, University of Southampton

Cindy Brooks, Doctoral Researcher and Research Fellow, University of Southampton

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 SummaryMost 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:

See the summary reports

See the recommendations and guidance on deprescribing for people with dementia or MCI

•We reviewed existing evidence on interventions to reduce or stop (deprescribe) medications for people with dementia or mild cognitive impairment (MCI).  We found that most studies focused on medications that affect behaviour, mood, or perceptions and people in residential care.  Many interventions reduced numbers of medications and improved appropriateness of medications. However, there was limited evidence on outcomes relating to safety and outcomes such as falls, quality of life and cognition.  There was limited involvement of patients and informal carers in the interventions.

•We interviewed people with dementia or MCI, informal carers, primary care professionals and professionals working in memory clinics. We found that patients, carers and healthcare staff need to be involved in the deprescribing process.  This process needs to consider patient cognitive abilities and independence.  It also needs to consider carer experiences.  Flexible medication management processes are needed to support successful deprescribing.  These should be adapted to each person.  These should involve joint working across the healthcare system.  Deprescribing discussions need to be held in-person and in a safe setting.  There needs to be enough time.  Discussions should be led by a professional who knows the patient and can answer their questions.  The possible impact of deprescribing decisions should be carefully considered.  This includes impact on how medication is managed day-to-day.  Also, carer burden.

What we did with the new knowledge

Sharing with frontline health and care professionals

•We shared our findings at a Hampshire and Isle of Wight Integrated Care Board (ICB) Medicines Optimisation webinar, engaging with an audience of 110 professionals, mostly pharmacists.

•We shared our findings at a Wessex Older People’s Mental Health Academic meeting involving more than 50 professionals working in this area, primarily doctors.

•Meeting with the national lead for NHS prescribing to present the study

Academic Publications

•We have submitted two papers for publication, one reporting the systematic review and the other the qualitative study.

•Presentation about using “photo elicitation” as a creative qualitative methodology at the ARC Qualitative Network

Sharing with the wider community including patient and public

Summary findings and infographics from the qualitative study have been shared on social media, with a post on the ARC Twitter/X, LinkedIn and Facebook pages, and the ARC website.

Where Next?

Grants:

Dr Kinda Ibrahim (University of Southampton) and Dr Rosemary Lim (University of Reading) is leading an RfPB grant application for a follow-on study . This will develop and test and deprescribing intervention for people with dementia or mild cognitive impairment in primary care.

Academic conferences:

1. The Society of Academic Primary Care conference attended mainly by GPs and academics.

2. The British Geriatric Society Conference attended by Health and care professionals interested and involved in care of older people (nurses, pharmacists, GPs, geriatricians, etc)

3. The Health Service Research and Pharmacy Practice conference attended mainly by pharmacists

Sharing with the public:

-Write a blog and share with the dementia support HIoW community group

-Write article for the conversation per previous invitation