Adapting the ShedMEDS Deprescribing Intervention to Dementia Care in Assisted Living

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Project Summary/Abstract OBJECTIVE: The primary objective of the pilot study is to implement and evaluate a patient/surrogate- centered deprescribing intervention previously used in the Shed-MEDS clinical trial 28,29,31 in a population of people living with dementia (PWD) who reside at Abe's Garden, a memory care assisted living (ALF). The aims of the study are to: 1) Determine the feasibility of implementing the Shed-MEDS deprescribing intervention among PWD residing in a dementia care ALF; 2) Document the effects of the Shed-MEDS deprescribing intervention on medication burden among PWD. and 3) Document the effects of the patient- centered deprescribing intervention (Shed-MEDS) on the quality of life in PWD. SIGNIFICANCE: Although PWD are more likely to have polypharmacy and take unnecessary medications, few studies have assessed deprescribing attitudes in this population. A recent showed that the majority of participants with dementia were agreeable to stopping a medication if advised by their physician.18 Proxy respondents in this study were less agreeable to deprescribing, echoing previous findings that have shown caregiver resistance to deprescribing of antipsychotics due to concern about the management of BPSD. 19,20 Sequelae associated with PIM use in PWD thus requires a better understanding of deprescribing attitudes in surrogate decision-makers. SETTING AND PARTICIPANTS: Abe's Garden provides residential and memory care for up to 42 PWD. On site medical care is provided by a gerontological nurse practitioner and geriatrician, both of whom are employed by Vanderbilt University Medical Center (VUMC). INNOVATION: This pilot study will be conducted in an ALF. ALFs may be optimal settings to engage surrogate decision-makers about deprescribing benefits for the health and well-being of PWD, but to date, they have been uncommon sites for deprescribing interventions. APPROACH: All residents and their surrogate decision-makers, will be approached for participation. Assessment tools to be administered by the study team include: 1) Surrogate Attitudes Toward Deprescribing (rPATD)14, 2) Shed MEDS deprescribing conversation guide, 3) Brief Intervention for Mental Status (BIMS)30 ; and, 4) DEMQOL-Proxy 32 POTENTIAL FOR IMPACT: The data from this study will inform the feasibility and implementation barriers and facilitators specific to PWD, their family proxies, and dementia care ALF staff. This information will inform tailored adaptations to the Shed-MEDS intervention in preparation for a multi-center R01 trial to test the clinical effectiveness of deprescribing among PWD in ALF care settings.