The value of deprescribing in older adults with dementia: a narrative review.

Introduction: Mitigating the burden of unnecessary polypharmacy or multiple medication use in people living with dementia has been recognized as a key priority internationally. One approach to reducing inappropriate polypharmacy is through medication withdrawal or deprescribing. The aim of this narrative review is to appraise current evidence on the safety and efficacy of deprescribing in older people with dementia.Area covered: Non-systematic searches of key databases including PubMed, Embase and Google Scholar were conducted from inception to 28th February 2021 for articles that assessed the safety and/or efficacy of deprescribing in older adults with dementia. Personal reference libraries were also utilized. Information pertaining to current clinical trials were found on clinicaltrial.gov.Expert opinion: There is limited direct evidence to inform deprescribing in older adults with dementia specifically. This review identified nineteen studies that have assessed the impact of deprescribing interventions to reduce inappropriate polypharmacy or direct deprescribing of specific medications. However, the current evidence is limited in scope as most studies focused on medication-related outcomes (i.e. discontinuation of high-risk medications, reduction in number of medications) rather than patient-centered outcomes in individuals living with dementia. Furthermore, most studies focused on addressing inappropriate polypharmacy in older adults with dementia living in long term care facilities, and interventions did not involve the person and their carer. Further evidence on the impact of deprescribing in this population across clinical settings is needed.