Andrews Nicola, Brooks Cindy, Board Michele, Fraser Simon, Latter Sue, Aplin Kirsty, McCausland Beth, Radcliffe Eloise, Amin Jay, Lim Rosemary, van Leeuwen Ellen, Ibrahim Kinda
School of Health Sciences, University of Southampton, Southampton, UK.
National Institute of Health and Care Research (NIHR) Applied Research Collaboration Wessex, Southampton, UK.
Drugs Aging. 2025 Apr;42(4):275-294. doi: 10.1007/s40266-025-01189-2. Epub 2025 Mar 11.
Polypharmacy is common amongst older people with dementia or mild cognitive impairment (MCI), increasing the risk of medication-related harm. Medicine optimisation and deprescribing to reduce polypharmacy is considered feasible, safe and can lead to improved health. However, for those living with dementia or MCI, this can be challenging. This systematic review aimed to summarise the evidence on the outcomes of medicine optimisation and deprescribing interventions for older people with dementia or MCI.
Literature was searched using CINAHL, Embase, Medline, PsychINFO, Web of Science and the Cochrane Library from database inception to January 2024. Papers reporting data specific to people with dementia or MCI from medicine optimisation and deprescribing interventional research studies of any design and in any setting were included. A narrative synthesis was conducted owing to heterogeneity of study designs and outcomes. Quality was assessed using the Mixed Methods Appraisal Tool.
A total of 32 papers reporting on 28 studies were included, with samples ranging from 29 to 17,933 patients and a mean patient age ranging from 74 to 88 years. Of the studies, 60% were undertaken in long-term care settings. Involvement of patients and/or carers in interventions was limited. Papers were grouped as either incorporating a medication review component (n = 13), education component (n = 5) or both (n = 14). Studies primarily focussed on medication-related outcomes, generally showing a positive effect on decreasing the number and improving appropriateness of medications. Fewer papers reported clinical outcomes (behavioural and psychological symptoms of dementia, falls, quality of life and cognition) with mixed findings. A reduction or no change in mortality or hospital attendance demonstrated safety of the interventions in the few papers reporting these outcomes. The quality of the evidence was mixed.
Medicine optimisation and deprescribing interventions generally reduced the number and increased the appropriateness of medications, and although less frequently reported, these interventions seemed to be safe and showed an absence of worsening of clinical outcomes. This review highlights a need for further research, particularly in people with dementia or MCI living at home, with more focus on clinical outcomes and a greater involvement of patients and informal carers.
The protocol was published in the International Prospective Register of Systematic Reviews (PROSPERO) [Ref: CRD42023398139].
多重用药在患有痴呆症或轻度认知障碍（MCI）的老年人中很常见，增加了药物相关伤害的风险。优化用药和减药以减少多重用药被认为是可行、安全的，并且可以改善健康状况。然而，对于患有痴呆症或MCI的人来说，这可能具有挑战性。本系统评价旨在总结关于痴呆症或MCI老年人优化用药和减药干预结果的证据。
从数据库建立至2024年1月，使用CINAHL、Embase、Medline、PsychINFO、Web of Science和Cochrane图书馆进行文献检索。纳入报告任何设计和任何环境下优化用药和减药干预研究中痴呆症或MCI患者特定数据的论文。由于研究设计和结果的异质性，进行了叙述性综合分析。使用混合方法评估工具评估质量。
共纳入报告28项研究的32篇论文，样本量从29例到17933例患者不等，患者平均年龄从
