Aligning Medications With What Matters Most: Conversations Between Pharmacists, People With Dementia, and Care Partners

Abstract

Introduction: Successful deprescribing for people with dementia (PWD) depends on communication about medication-related priorities between PWD, care partners and clinicians. The objective of this study was to gain in-depth knowledge of how elicitation of PWD and care partner medication-related priorities during a deprescribing intervention shaped discussions with pharmacists about medications. Methods: Qualitative analysis of audio-recorded interactions between pharmacists and patient-care partner dyads in a pilot study of a pharmacist-led deprescribing intervention for PWD in primary care. Patients ≥ 65 years taking ≥ 7 medications and care partners were recruited from an integrated delivery system in Colorado and a community-based medical practice in Maryland. Qualitative content analysis was used to analyze 82 transcripts from encounters with 55 patient-care partner dyads. Results: The mean (SD) age of PWD was 81 (8.1) years; 45% were women, 33% Black, and 15% Hispanic. PWD took an average of 13 (±5.3) medications at baseline. Care partners were on average 66 (13) years of age and most were spouses/partners of the PWD. Content analysis identified five themes: (1) Reducing medication-related treatment burden; (2) Alleviating burdensome symptoms; (3) Maintaining cognition and function; (4) Discussion of tradeoffs; (5) Challenges to deprescribing. After eliciting patient and care partner priorities, pharmacists recommended both deprescribing and prescribing. Conclusion: Findings from this secondary analysis of a pilot deprescribing intervention suggest eliciting medication-related priorities of PWD and care partners can support goal-concordant care. These results can inform development of interventions to optimize medications for this population.