Deprescribing Central Nervous System-Active Medications Among Community-Dwelling Older Adults with Dementia in Primary Care: A Feasibility Study

Central nervous system (CNS)-active medications pose serious health risks for older adults with dementia but are nonetheless commonly used. Few deprescribing interventions have focused on people with dementia. We conducted a one-arm pilot study in six primary care practices of an integrated healthcare system between February and August 2023. The deprescribing intervention consisted of patient/care partner education and self-management materials and provider decision support. Participants were aged 60+ with diagnosed dementia and prescribed at least one CNS-active medication for three or more months of the six-month period prior to study start. We assessed feasibility and acceptability of the intervention and feasibility of ascertaining medication discontinuation and medically treated falls. The intervention was delivered to all (<i>N</i> = 114) eligible participants; their mean age was 80 ± 9 years; 72% were female and 13% non-White. Intervention acceptability, assessed by Weiner's Acceptability of Intervention measure, was rated 3.5/5 (range 1-5; higher scores indicate higher acceptability). Among baseline antipsychotic users (<i>N</i> = 89), 39 (43.8%) had discontinued at follow-up. Among baseline tricyclic antidepressant users (<i>N</i> = 11), 6 (54.5%) had discontinued at follow-up. Among baseline skeletal muscle relaxant users (<i>N</i> = 3), 2 (66.7%) had discontinued at follow-up. Among baseline benzodiazepine users (<i>N</i> = 3), 1 (33.3%) had discontinued at follow-up. Among baseline opioid users (<i>N</i> = 13), 1 (7.7%) had discontinued at follow-up. Medically treated falls occurred among 22% at baseline vs. 21% at follow-up. The intervention is feasible and acceptable and may achieve meaningful reduction in CNS-active medication prescriptions. Findings support a controlled trial with sufficient power to assess effects on relevant clinical outcomes.