Ethics of Medication Deprescribing in Dementia Care

项目总结/摘要 老年人的药物使用已成为研究人员、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、预期寿命和代理决策。虚弱的老年人和最年长的老人的风险增加 由于患有多种慢性疾病， 由于许多因素导致的不良反应，包括衰老的生理变化，药物-疾病相互作用， 和药物间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的敏感性增加 毒品“老年痴呆症护理中药物处方的伦理”项目将招募20-25名护理人员， 与研究团队的时间访谈。护理者受试者将是那些已经入组IN-PEACE RCT的父母 R 01补助金的总体目标是，IN-PEACE （印第安纳州版本的姑息卓越的阿尔茨海默氏症护理工作）由萨克斯博士的团队是为了改善护理 社区居住的中度至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护理干预与 痴呆症姑息治疗的创新干预。这项定性研究旨在探讨 对社区居住照顾者决定取消处方药物的态度和经验 中重度AD患者，重点是从护理人员那里了解伦理考虑因素， 他们考虑到。此外，根据以往的经验和可能发生的情况， 在和平的过程中，我们将从照顾者那里了解他们对发生的对话的偏好 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（亲自或通过电话）和定性方法进行分析 录音采访的录音。数据分析将使用开放编码的访谈数据进行 逐行归纳识别和标记想法，并制定一个共同的代码清单， 主题.这一额外的数据收集将通过更好地了解护理人员的 关于取消处方的观点，包括从父母内部可能自然发生的对话中学习 study.它还将产生试点数据，为痴呆症的开药提供信息，并帮助 准备一个单独的，随后的研究，一个取消处方干预。

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.