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Barriers to Optimising Prescribing and Deprescribing in Older Adults with Dementia: A Narrative Review
Reeve E, Bell JS, Hilmer SN.. Current clinical pharmacology, 2015-01-01
Topic: Health services, long-term care and technology
Older adults with dementia commonly have multiple chronic conditions that prompt clinicians to prescribe medications. While dementia is a life-limiting disease, progression from mild cognitive impairment to end stage dementia is a process that can occur over many years and may not take a predetermined course. Therefore aligning pharmacological treatment with changing goals of care can be challenging. The aim of this narrative review was to explore barriers to optimising prescribing and deprescribing (withdrawing) of medications as the goal of care shifts from prolonging life to optimising quality of life. Optimising pharmacological treatment to help people with dementia achieve their goals of care often requires deprescribing of medications that are inappropriate, as well as initiating appropriate medications. Medical practitioner, system, patient and carer related barriers to optimisation of medications in older adults with multiple morbidities have been identified including: inadequate guidelines, incomplete medical histories, lack of time, avoidance of negative consequences, established beliefs in the benefits and harms of medication use and others. Optimising prescribing for older people with dementia is further complicated by diminished decision making capacity, difficulties with comprehension and communication, increasing involvement of carers and difficulties establishing goals of care. Further research is required into the attitudes, beliefs and preferences of people with dementia and their carers regarding prescribing and deprescribing.
Key findings
- The aim of this narrative review was to explore barriers to optimising prescribing and deprescribing (withdrawing) of medications as the goal of care shifts from prolonging life to optimising quality of life.
- Optimising pharmacological treatment to help people with dementia achieve their goals of care often requires deprescribing of medications that are inappropriate, as well as initiating appropriate medications.
- Medical practitioner, system, patient and carer related barriers to optimisation of medications in older adults with multiple morbidities have been identified including: inadequate guidelines, incomplete medical histories, lack of time, avoidance of negative consequences, established beliefs in the benefits and harms of medication use and others.
- Optimising prescribing for older people with dementia is further complicated by diminished decision making capacity, difficulties with comprehension and communication, increasing involvement of carers and difficulties establishing goals of care.
- Further research is required into the attitudes, beliefs and preferences of people with dementia and their carers regarding prescribing and deprescribing.
Study details
- Study designnarrative review
- Evidence strengthLow
How this study scored 36/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it. We have no data on journal's citation record, times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 21 of the 58 points we could judge it on, which is 36 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Current clinical pharmacology) |
| Journal's citation record | — / 4 | No journal record from OpenAlex — left out of this score |
| Study design | 0 / 12 | Design recorded as “narrative review”, which our rubric does not rank (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 1 / 5 | 2015 — within 20 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 26338170) |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 21 / 58 | Scored on 11 of 20 parts. We have no data for the rest, so they are left out: 21 of the 58 points we could judge it on is 36 out of 100. |
| Total | 36 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
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APA 7th
Reeve, E., Bell, J. S., & Hilmer, S. N. (2015). Barriers to Optimising Prescribing and Deprescribing in Older Adults with Dementia: A Narrative Review. Current clinical pharmacology. https://doi.org/10.2174/157488471003150820150330
Vancouver
Reeve E, Bell JS, Hilmer SN. Barriers to Optimising Prescribing and Deprescribing in Older Adults with Dementia: A Narrative Review. Current clinical pharmacology. 2015. doi:10.2174/157488471003150820150330. PMID: 26338170.
BibTeX
@article{reeve2015-26338170,
author = {Reeve, E. and Bell, J. S. and Hilmer, S. N.},
title = {{Barriers to Optimising Prescribing and Deprescribing in Older Adults with Dementia: A Narrative Review}},
journal = {Current clinical pharmacology},
year = {2015},
doi = {10.2174/157488471003150820150330},
pmid = {26338170},
url = {https://doi.org/10.2174/157488471003150820150330}
}