Bates Clare, Efstathiou Nikolaos, Sutton Claire, Hamed Nesrein, Maidment Ian
School of Nursing and Midwifery, University of Birmingham, Birmingham, UK
ENRICH, West Midlands RRDN, NIHR, Birmingham, UK.
BMJ Open. 2025 Mar 26;15(3):e085812. doi: 10.1136/bmjopen-2024-085812.
As people get older, they tend to take more preventive medication such as statins, beta-blockers and anti-coagulants to help prolong their lives. The risks of taking medication can start to outweigh the benefits in older people, and whether those with comorbidities want to extend these years of poor health is another consideration. One-third of older people will develop dementia, and they may not have the mental capacity to decide whether to continue or withdraw preventive medication. In these cases, deprescribing is left to advocates, such as healthcare professionals and family members. This systematic review will look at the views of stakeholders, including advocates, people living with dementia and any other people involved in the decision-making process for deprescribing preventive medication in dementia.
A systematic review of qualitative evidence using thematic synthesis and an inductive approach will be conducted. The following databases and platforms will be searched: Embase, HMIC, MEDLINE, PsycINFO, CINAHL, PubMed, Cochrane Central Library, OATD, ProQuest, Scopus and the Web of Science, along with manual searches through citation mining and grey literature. Only primary qualitative studies (or the qualitative elements of mixed method studies) will be used. There will be no date limit, and the search will be completed by April 2025. Only English-language articles will be used. The included studies will present views and experiences about deprescribing specifically preventive medication in dementia cases. Principles identified by Cochrane for qualitative studies will be used as guidance. Covidence will facilitate two independent reviewers to identify relevant studies, and the Critical Appraisal Skills Programme and Mixed Methods Appraisal Tool will be used to assess quality. NVivo will be used to manage the extracted findings from the included studies.
Ethical approval is not applicable for this study as no original data is going to be collected as it is a systematic review. The findings will be disseminated in a peer-reviewed open-access publication and at conference presentations.
CRD42023476394. Any changes made to the protocol will be reported on PROSPERO.
随着人们年龄的增长，他们倾向于服用更多的预防性药物，如他汀类药物、β受体阻滞剂和抗凝血剂，以帮助延长寿命。在老年人中，用药的风险可能开始超过益处，而患有合并症的人是否想要延长这些健康状况不佳的岁月则是另一个需要考虑的问题。三分之一的老年人会患上痴呆症，他们可能没有能力决定是否继续或停止服用预防性药物。在这些情况下，减药工作就留给了倡导者，如医疗保健专业人员和家庭成员。本系统评价将探讨利益相关者的观点，包括倡导者、痴呆症患者以及参与痴呆症预防性药物减药决策过程的任何其他人。
将采用主题综合和归纳法对定性证据进行系统评价。将检索以下数据库和平台：Embase、HMIC、MEDLINE、PsycINFO、CINAHL、PubMed、Cochrane 中央图书馆、OATD、ProQuest、Scopus 和科学网，同时通过引文挖掘和灰色文献进行手工检索。仅使用原发性定性研究（或混合方法研究的定性要素）。没有日期限制，检索将于2025年4月完成。仅使用英文文章。纳入的研究将呈现关于在痴呆症病例中减用特定预防性药物的观点和经验。Cochrane 为定性研究确定的原则将用作指导。Covidence 将协助两名独立评审员识别相关研究，批判性评价技能计划和混合方法评价工具将用于评估质量。NVivo 将用于管理从纳入研究中提取的结果。
由于本研究是一项系统评价，不收集原始数据，因此无需伦理批准。研究结果将在同行评审的开放获取出版物和会议报告中传播。
PROSPERO 注册号：CRD42023476394。对方案所做的任何更改将在 PROSPERO 上报告。
