The Importance of a Relationship-Centred Approach to Deprescribing for People with Dementia or Mild Cognitive Impairment in Primary Care: A Qualitative Study.

Polypharmacy (taking five or more regular medications) is common in people with dementia or mild cognitive impairment (MCI) and is associated with poor outcomes such as decline in cognitive and physical functioning, falls and hospital admission. Reducing or stopping unnecessary medications (deprescribing) can help improve outcomes but limited research has been undertaken with people with dementia or MCI, especially in primary care. This study explored the perspectives and experiences of people with dementia or MCI, informal carers and healthcare professionals on deprescribing decision-making in this setting. Seven people with dementia, two people with MCI and nine informal carers took part in photo elicitation and an in-person interview. They took photographs of their day-to-day management of medication, which were used during the interview to probe the conversation. Sixteen healthcare professionals, including general practitioners, pharmacists, nurses, social prescribers and National Health Service memory clinic professionals, participated in individual online interviews. Data was analysed using inductive thematic analysis. Findings suggest the need to navigate 'patient vs carer vs professional voices' in the deprescribing process to ensure everyone's voice is included. It should take into account patient cognitive abilities, autonomy and independence, as well as carer experiences and the need for a written summary of what has been discussed and agreed. Flexible, tailored, cross-system medication management processes are needed to support effective deprescribing, including proactive follow-up. To facilitate deprescribing discussions, factors such as professional knowledge, safe environment, and sufficient time should be considered. Finally, careful consideration should be given to the potential impact of deprescribing decisions on day-to-day medication management and carer burden. These findings provide novel insights that demonstrate the need for a relationship-centred approach for deprescribing for people with dementia or MCI, which should inform future research on development of a primary care deprescribing intervention for this group of people.