What are the views of the key stakeholders in deprescribing preventive medication in dementia?
Problem
As a care home nurse, I administer preventive medication (such as anti-coagulants, beta-blockers, and statins) to people with dementia, who mostly do not have the mental capacity to consent to taking these medications. I do not know if my residents want to take these medications, and this poses an ethical dilemma with two issues. Firstly, there is increasing evidence that many preventive medications can do more harm than good in older populations. Secondly, whether people with dementia want to take preventive medication to prolong this period of their lives needs to be considered. Everyone has the legal right to refuse treatment, even life-sustaining medication such as insulin, but when someone does not have mental capacity, they are no longer able to make these decisions. Deprescribing is a complex subject even when the person has full mental capacity, but when someone lacks mental capacity, the decision-making is left to general practitioners, nurses, pharmacists, and the person’s family or advocate. This will be the first systematic review to look at these stakeholders’ views on deprescribing in this very sensitive situation.
Approach
The systematic review will explore qualitative evidence from Embase, HMIC, MEDLINE, PsycINFO, CINAHL, PubMed, Cochrane Library, ProQuest, Scopus and the Web of Science. Covidence will be used to assist in the review of the selected articles, and this will be reported on a PRISMA flowchart. Cochrane guidance for qualitative evidence synthesis will be followed and the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool will be used to assess the quality of the studies. Thomas and Harden’s thematic synthesis approach will be used to identify themes, and this will be managed using NVivo.
Findings
This work is ongoing, but the study will be completed soon and the findings ready to present, by poster, for the conference. To maintain an unbiased stance, as best as possible, I do not want to try to predict what these findings may be.
Consequences
This work will underpin my PhD, which aims to look at whether the general population would wish to have their preventive medication deprescribed if they were to get dementia in the future and if so whether they can clearly state at what stage of dementia they would want to deprescribe their medication. This has clear implications for sustainability: with a growing population of people with dementia, we do not want to be enforcing treatment on people who would have considered their quality of life too poor to keep prolonging.