STOP-DEM - Deprescribing for people with cognitive impairment
Research type
Research Study
Full title
Development of a structured deprescribing intervention involving shared decision-making for people with dementia or mild cognitive impairment in primary care (STOP-DEM)
IRAS ID
325681
Contact name
Kinda Ibrahim
Contact email
Sponsor organisation
University of Southampton
Duration of Study in the UK
1 years, 3 months, 30 days
Research summary
Summary of Research
This qualitative study aims to explore how healthcare staff could improve involvement of people with dementia or mild cognitive impairment (MCI) and their caregivers in shared decision-making about stopping or reducing potentially harmful medication (deprescribing). Identifying inappropriate medications and deprescribing has the potential to improve outcomes for people with dementia or MCI.
Most people with dementia or MCI have multiple long-term conditions and take five or more regular medications (polypharmacy). Polypharmacy in people with dementia or MCI can lead to increased risk of drug interactions, side effects such as falls and cognitive decline, and sometimes hospitalisation and death. It is estimated that over £400 million is spent annually in the UK on hospital admissions related to harm from medications.
To date, deprescribing interventions for people with dementia or MCI have been limited to inpatient or nursing home settings. Yet, it is estimated that 61% of people with dementia in the UK live at home where medication is a part of daily living. Most studies have focused on medication-related outcomes rather than person-centred outcomes and did not involve the person with dementia and their caregiver.
This study is funded by the Applied Research Collaboration Wessex and will run for fourteen months. We will ask people with dementia or MCI and their caregivers about their views and experiences, facilitated by photographs they will be asked to take for the study. We will also interview healthcare professionals working in primary care. We will be recruiting eligible participants from the Wessex area. We want to understand how deprescribing can be initiated and monitored for people with dementia or MCI in the primary care setting and how patients and their caregivers could be involved in decisions about medication taking.We will use the study findings to inform development of a primary care deprescribing intervention.
Summary of Results
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 staff member 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.3. How has this study helped patients and researchers?
Our findings show that ways to ensure patients, carers and healthcare staff can work together need to be put in place. This means taking a relationship-centred approach to deprescribing for people with dementia or MCI. This approach has been recognised as important in other areas when caring for people with dementia.The findings highlight changes to current practice that can help patients and carers. These include:
• Awareness of cognitive problems, for example, by providing a written summary of discussions.
• Discussing the impact on how medication is managed day-to-day by patients and carers before a deprescribing decision is made.For researchers, the findings show that future work is needed. There is a need to create deprescribing interventions for people with dementia or MCI. A further study is planned to develop and test a primary care intervention.
4. Where can I learn more about this study?
Details of the study are available at: https://gbr01.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftrack.pstmrk.it%2F3ts%2Fwww.arc-wx.nihr.ac.uk%252Fresearch-areas-list%252Fcompleted%25253A-development-of-a-structured-deprescribing-intervention-for-people-with-dementia-or-mild-cognitive-impairment-in-primary-care-&data=05%7C02%7Clondoncentral.rec%40hra.nhs.uk%7Ca2bcb6b277c24e32120408ddf5079615%7C8e1f0acad87d4f20939e36243d574267%7C0%7C0%7C638936135129338224%7CUnknown%7CTWFpbGZsb3d8eyJFbXB0eU1hcGkiOnRydWUsIlYiOiIwLjAuMDAwMCIsIlAiOiJXaW4zMiIsIkFOIjoiTWFpbCIsIldUIjoyfQ%3D%3D%7C0%7C%7C%7C&sdata=SmOt48bkrY5pOlCs9AjVmWjJwV2FuMZrg%2BOB1PPQa1Y%3D&reserved=0(stop-dem)/NBTI/VxPAAQ/AQ/b8ac8925-56bc-48d9-8c58-6b83c4631cd0/1/R28Pgtt8KXAn academic paper has been accepted for publication by the journal Dementia.
REC name
London - Central Research Ethics Committee
REC reference
23/PR/0366
Date of REC Opinion
11 Apr 2023
REC opinion
Favourable Opinion