Abstract
BackgroundSystems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia.MethodsStudies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 – August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually.ResultsEight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals’ opinions on appropriateness of specific medications in different clinical scenarios.ConclusionsFuture research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.
Highlights
Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation
Generalizability to people with advanced dementia is limited by pathophysiological changes as dementia progresses and the fact that systems have not been developed for use where goals of care are palliative
Eligibility criteria Articles needed to be published in a peer-reviewed English language journal and report on a system or recommendations for identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care
Summary
Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The harm/benefit risk ratios of numerous medications are Several systems for identifying potentially inappropriate medications in older adults have been developed to operationally define the harm/benefit risk in clinical practice and research [4, 5]. These systems have been applied in early but not advanced dementia [6, 7].
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