Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study

Elizabeth A. Phelan (), Benjamin H. Balderson, Monica M. Fujii, Vina F. Graham, Mary Kay Theis and Shelly L. Gray
Additional contact information
Elizabeth A. Phelan: Department of Medicine, Division of Gerontology and Geriatric Medicine, School of Medicine, University of Washington, Seattle, WA 98104, USA
Benjamin H. Balderson: Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA 98101, USA
Monica M. Fujii: Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA 98101, USA
Vina F. Graham: Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA 98101, USA
Mary Kay Theis: Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA 98101, USA
Shelly L. Gray: Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA 98195, USA

IJERPH, 2025, vol. 22, issue 11, 1-9

Abstract: 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.

Keywords: aged; dementia; falls; potentially inappropriate medication list; deprescriptions; primary health care (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
References: Add references at CitEc
Citations:

Downloads: (external link)
https://www.mdpi.com/1660-4601/22/11/1611/pdf (application/pdf)
https://www.mdpi.com/1660-4601/22/11/1611/ (text/html)

Related works:
This item may be available elsewhere in EconPapers: Search for items with the same title.

Export reference: BibTeX RIS (EndNote, ProCite, RefMan) HTML/Text

Persistent link: https://EconPapers.repec.org/RePEc:gam:jijerp:v:22:y:2025:i:11:p:1611-:d:1777478

Access Statistics for this article

IJERPH is currently edited by Ms. Jenna Liu

More articles in IJERPH from MDPI
Bibliographic data for series maintained by MDPI Indexing Manager ().