Medication use in older adults has become a high priority issue for researchers, insurers, policy makers, and clinicians, but there has been insufficient attention to the underlying ethical issues of patient preferences, goals of care, life expectancy, and surrogate decision making. Frail older adults and the oldest-old are at increased risk both of exposure to polypharmacy because of having multiple chronic conditions as well as greater risk of adverse effects due to numerous factors including physiological changes of aging, drug-disease interactions, and drug-drug interactions. Individuals with Alzheimer disease and related dementias (ADRD) have additional physiological risks, for example, due to greater sensitivity to psychoactive medications and anti-cholinergic drugs. The ?Ethics of Medication Deprescribing in Dementia Care? project will enroll 20-25 caregivers for a one- time interview with the study team. Caregiver subjects will be those already enrolled in IN-PEACE RCT parent grant and randomized to the intervention arm. The overarching goal of the parent R01 grant, IN-PEACE (Indiana version of Palliative Excellence in Alzheimer Care Efforts) by Dr. Sachs?s team is to improve the care of community dwelling patients with moderate to severe dementia and their family caregivers through an innovative model of supportive care that combines an existing, evidence-based intervention for dementia care with an innovative intervention for palliative care in dementia. This proposed qualitative study aims to explore the attitudes toward and experience with decisions to deprescribe medications of caregivers for community dwelling patients with moderate-severe AD with a focus on learning from the caregivers the ethical considerations that they take into account. In addition, based on both prior experiences and those that may be transpiring during the course of IN-PEACE, we will learn from caregivers their preferences regarding the conversations that take place around deprescribing decisions and any barriers or facilitators encountered in these discussions. The study will employ semi-structured interviews (in-person or by telephone) and qualitative methods for analyzing transcriptions of the recorded interviews. Data analysis will be conducted using open coding of interview data line by line to inductively identify and label ideas and to develop a common list of codes and to discuss emerging themes. This additional data collection will enhance the IN-PEACE RCT by better understanding caregivers? perspectives on deprescribing, including learning from conversations that might occur naturally within the parent study. It also will generate pilot data that would inform the field of deprescribing in dementia, as well as aid in preparing a separate, subsequent study of a deprescribing intervention.
Medication use in older adults has become a high priority issue for researchers, insurers, policy makers, and clinicians, but there has been insufficient attention to the underlying ethical issues of patient preferences, goals of care, life expectancy, and surrogate decision making. Frail older adults, and individuals with Alzheimer?s disease and related dementias (ADRD) are at increased risk both of exposure to polypharmacy because of having multiple chronic conditions as well as greater risk of adverse effects. This supplement to the innovative IN-PEACE trial on palliative care for patients with moderate to severe dementia in the community will go beyond existing research to explore caregivers? perspectives on the ethical considerations of deprescribing medications, including preferences for communication on this topic.
