Abstract
Background
People living with dementia often continue to take preventive medication until the end of their lives, largely with the aim of prolonging life. However, at the later stages of dementia, a palliative-only, symptom-controlling approach, may be more appropriate. Also, the efficacy of preventive medications in older people is often unclear and the side effects may have a negative impact on quality of life, yet these medicines are often not deprescribed.
Aim
To synthesise qualitative evidence of healthcare professionals’ and family members’ views on deprescribing preventive medication for people living with dementia.
Methods
The systematic review was conducted using the principles for systematic reviews of qualitative evidence provided by Cochrane. In May 2025, keywords were searched for in Embase, Health Management Information Consortium, MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, Open Access Theses and Dissertations, Web of Science, ProQuest, Cochrane Central Library and Google Scholar to identify suitable studies from pre-defined eligibility criteria. The Critical Appraisal Skills Programme was used for quality appraisal and Thomas and Harden’s qualitative thematic synthesis for synthesising findings.
Results
Eighteen studies were included. Five themes were identified: the decision-makers, reactive reasons to deprescribe, barriers and facilitators to proactive deprescribing, difficulties for family members and the timing of deprescribing decisions. Guidance is often unclear for this complex group, but guidance is unlikely to cover every individuals’ unique situation. Ideally, in practice, deprescribing should occur before someone gets to a stage when they can no longer communicate side effects and this may instigate more deprescribing discussions. To assist deprescribing, recording why a medication was started on the prescription could make it clearer whether to discontinue it at a later stage.
Conclusion
Deprescribing conversations are difficult for both healthcare professionals and family members. Future research could explore the role of advance care planning for deprescribing preventive medications, before someone is diagnosed with dementia, so decision-makers are aware of what the person would have wanted. This may make deprescribing less time-consuming, provide guidance and reduce the burden for the decision-makers.
People living with dementia often continue to take preventive medication until the end of their lives, largely with the aim of prolonging life. However, at the later stages of dementia, a palliative-only, symptom-controlling approach, may be more appropriate. Also, the efficacy of preventive medications in older people is often unclear and the side effects may have a negative impact on quality of life, yet these medicines are often not deprescribed.
Aim
To synthesise qualitative evidence of healthcare professionals’ and family members’ views on deprescribing preventive medication for people living with dementia.
Methods
The systematic review was conducted using the principles for systematic reviews of qualitative evidence provided by Cochrane. In May 2025, keywords were searched for in Embase, Health Management Information Consortium, MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, PubMed, Open Access Theses and Dissertations, Web of Science, ProQuest, Cochrane Central Library and Google Scholar to identify suitable studies from pre-defined eligibility criteria. The Critical Appraisal Skills Programme was used for quality appraisal and Thomas and Harden’s qualitative thematic synthesis for synthesising findings.
Results
Eighteen studies were included. Five themes were identified: the decision-makers, reactive reasons to deprescribe, barriers and facilitators to proactive deprescribing, difficulties for family members and the timing of deprescribing decisions. Guidance is often unclear for this complex group, but guidance is unlikely to cover every individuals’ unique situation. Ideally, in practice, deprescribing should occur before someone gets to a stage when they can no longer communicate side effects and this may instigate more deprescribing discussions. To assist deprescribing, recording why a medication was started on the prescription could make it clearer whether to discontinue it at a later stage.
Conclusion
Deprescribing conversations are difficult for both healthcare professionals and family members. Future research could explore the role of advance care planning for deprescribing preventive medications, before someone is diagnosed with dementia, so decision-makers are aware of what the person would have wanted. This may make deprescribing less time-consuming, provide guidance and reduce the burden for the decision-makers.
| Original language | English |
|---|---|
| Journal | BMC Geriatrics |
| Early online date | 18 Apr 2026 |
| DOIs | |
| Publication status | E-pub ahead of print - 18 Apr 2026 |
Bibliographical note
Copyright © The Author(s) 2026. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s CreativeCommons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.
Funding
CB is a Pre-doctoral Clinical and Practitioner Academic Fellow supported by the National Institute for Health and Care Research and funded by the Department of Health and Social Care. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the National Institute for Health and Care Research or the Department of Health and Social Care.
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