Ethics of Medication Deprescribing in Dementia Care

项目摘要/摘要 老年人的用药已成为研究人员、保险公司、政策制定者和 临床医生，但对患者偏好、目标等潜在的伦理问题关注不够 护理、预期寿命和代孕决策。体弱多病的老年人和高龄老人的风险更高 由于有多种慢性病以及更大的风险，两人都接触过多药 由多种因素引起的不良反应，包括衰老的生理变化，药物与疾病的相互作用， 以及药物与药物的相互作用。阿尔茨海默病和相关痴呆(ADRD)患者有额外的 生理风险，例如，由于对精神活性药物和抗胆碱能药物更敏感 毒品。“痴呆症护理中用药停药的道德”项目将招募20-25名照顾者参加一项- 《时代周刊》采访研究团队。照顾者主题将是那些已经在IN-PARE RCT家长中注册的人 授予并随机分配到干预组。家长R01赠款的首要目标是和平 (印第安纳州版在阿尔茨海默氏症护理方面的卓越缓和努力)由萨克斯博士的团队致力于改善 社区居住的中重度痴呆症患者及其家庭照顾者通过创新的 一种支持性护理模式，将现有的基于证据的痴呆症干预与 痴呆症姑息治疗的创新干预。这项拟议的定性研究旨在探索 对社区居所照顾者停药决定的态度和经验 中-重度AD患者注重从照顾者那里学习伦理考虑 他们考虑到了。此外，根据以前的经验和可能在 在和平的过程中，我们将从照顾者那里了解他们对所发生的对话的偏好 关于取消处方的决定以及在这些讨论中遇到的任何障碍或促进者。这项研究将 采用半结构化访谈(面谈或电话)和定性方法进行分析 录音采访的文字记录。将使用访谈数据的开放式编码进行数据分析 逐行归纳识别和标记想法，制定通用代码列表并讨论新出现的问题 主题。这一额外的数据收集将通过更好地了解照顾者的 对停药的看法，包括从父母内部可能自然发生的对话中学习 学习。它还将产生试点数据，向痴呆症停药领域提供信息，以及帮助 准备一项单独的后续研究，以进行停药干预。

PROJECT SUMMARY/ABSTRACT Medication use in older adults has become a high priority issue for researchers, insurers, policy makers, and clinicians, but there has been insufficient attention to the underlying ethical issues of patient preferences, goals of care, life expectancy, and surrogate decision making. Frail older adults and the oldest-old are at increased risk both of exposure to polypharmacy because of having multiple chronic conditions as well as greater risk of adverse effects due to numerous factors including physiological changes of aging, drug-disease interactions, and drug-drug interactions. Individuals with Alzheimer disease and related dementias (ADRD) have additional physiological risks, for example, due to greater sensitivity to psychoactive medications and anti-cholinergic drugs. The “Ethics of Medication Deprescribing in Dementia Care” project will enroll 20-25 caregivers for a one- time interview with the study team. Caregiver subjects will be those already enrolled in IN-PEACE RCT parent grant and randomized to the intervention arm. The overarching goal of the parent R01 grant, IN-PEACE (Indiana version of Palliative Excellence in Alzheimer Care Efforts) by Dr. Sachs’s team is to improve the care of community dwelling patients with moderate to severe dementia and their family caregivers through an innovative model of supportive care that combines an existing, evidence-based intervention for dementia care with an innovative intervention for palliative care in dementia. This proposed qualitative study aims to explore the attitudes toward and experience with decisions to deprescribe medications of caregivers for community dwelling patients with moderate-severe AD with a focus on learning from the caregivers the ethical considerations that they take into account. In addition, based on both prior experiences and those that may be transpiring during the course of IN-PEACE, we will learn from caregivers their preferences regarding the conversations that take place around deprescribing decisions and any barriers or facilitators encountered in these discussions. The study will employ semi-structured interviews (in-person or by telephone) and qualitative methods for analyzing transcriptions of the recorded interviews. Data analysis will be conducted using open coding of interview data line by line to inductively identify and label ideas and to develop a common list of codes and to discuss emerging themes. This additional data collection will enhance the IN-PEACE RCT by better understanding caregivers’ perspectives on deprescribing, including learning from conversations that might occur naturally within the parent study. It also will generate pilot data that would inform the field of deprescribing in dementia, as well as aid in preparing a separate, subsequent study of a deprescribing intervention.