TY - JOUR
AU - E. A. Phelan
AU - B. H. Balderson
AU - M. M. Fujii
AU - V. F. Graham
AU - M. K. Theis
AU - S. L. Gray
A1 - 
AB - Central nervous system (CNS)-active medications pose serious health risks for older adults with dementia but are nonetheless commonly used. Few deprescribing interventions have focused on people with dementia. We conducted a one-arm pilot study in six primary care practices of an integrated healthcare system between February and August 2023. The deprescribing intervention consisted of patient/care partner education and self-management materials and provider decision support. Participants were aged 60+ with diagnosed dementia and prescribed at least one CNS-active medication for three or more months of the six-month period prior to study start. We assessed feasibility and acceptability of the intervention and feasibility of ascertaining medication discontinuation and medically treated falls. The intervention was delivered to all (N = 114) eligible participants; their mean age was 80 ± 9 years; 72% were female and 13% non-White. Intervention acceptability, assessed by Weiner's Acceptability of Intervention measure, was rated 3.5/5 (range 1-5; higher scores indicate higher acceptability). Among baseline antipsychotic users (N = 89), 39 (43.8%) had discontinued at follow-up. Among baseline tricyclic antidepressant users (N = 11), 6 (54.5%) had discontinued at follow-up. Among baseline skeletal muscle relaxant users (N = 3), 2 (66.7%) had discontinued at follow-up. Among baseline benzodiazepine users (N = 3), 1 (33.3%) had discontinued at follow-up. Among baseline opioid users (N = 13), 1 (7.7%) had discontinued at follow-up. Medically treated falls occurred among 22% at baseline vs. 21% at follow-up. The intervention is feasible and acceptable and may achieve meaningful reduction in CNS-active medication prescriptions. Findings support a controlled trial with sufficient power to assess effects on relevant clinical outcomes.
AD - Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, WA 98104, USA.; Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA 98195, USA.; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA 98101, USA.; Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA 98195, USA.
AN - 41302558
BT - Int J Environ Res Public Health
C5 - Healthcare Disparities
CP - 11
DA - Oct 22
DO - 10.3390/ijerph22111611
DP - NLM
ET - 20251022
IS - 11
JF - Int J Environ Res Public Health
LA - eng
N2 - Central nervous system (CNS)-active medications pose serious health risks for older adults with dementia but are nonetheless commonly used. Few deprescribing interventions have focused on people with dementia. We conducted a one-arm pilot study in six primary care practices of an integrated healthcare system between February and August 2023. The deprescribing intervention consisted of patient/care partner education and self-management materials and provider decision support. Participants were aged 60+ with diagnosed dementia and prescribed at least one CNS-active medication for three or more months of the six-month period prior to study start. We assessed feasibility and acceptability of the intervention and feasibility of ascertaining medication discontinuation and medically treated falls. The intervention was delivered to all (N = 114) eligible participants; their mean age was 80 ± 9 years; 72% were female and 13% non-White. Intervention acceptability, assessed by Weiner's Acceptability of Intervention measure, was rated 3.5/5 (range 1-5; higher scores indicate higher acceptability). Among baseline antipsychotic users (N = 89), 39 (43.8%) had discontinued at follow-up. Among baseline tricyclic antidepressant users (N = 11), 6 (54.5%) had discontinued at follow-up. Among baseline skeletal muscle relaxant users (N = 3), 2 (66.7%) had discontinued at follow-up. Among baseline benzodiazepine users (N = 3), 1 (33.3%) had discontinued at follow-up. Among baseline opioid users (N = 13), 1 (7.7%) had discontinued at follow-up. Medically treated falls occurred among 22% at baseline vs. 21% at follow-up. The intervention is feasible and acceptable and may achieve meaningful reduction in CNS-active medication prescriptions. Findings support a controlled trial with sufficient power to assess effects on relevant clinical outcomes.
PY - 2025
SN - 1661-7827 (Print); 1660-4601
ST - Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study
T1 - Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study
T2 - Int J Environ Res Public Health
TI - Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study
U1 - Healthcare Disparities
U3 - 10.3390/ijerph22111611
VL - 22
VO - 1661-7827 (Print); 1660-4601
Y1 - 2025
ER -