Multidisciplinary perspectives on medication-related decision-making for people with advanced dementia living in long-term care: a critical incident analysis

Domenica Disalvo, Tim Luckett, Alexandra Bennett, Patricia M. Davidson, Meera Agar

Research output: Contribution to journalArticle

Abstract

Purpose: This study aimed to explore medication-related decision-making by health professionals from different disciplines and specialties caring for people with advanced dementia living in long-term care facilities, focusing on dilemmas associated with starting, continuing or deprescribing medications commonly regarded as potentially inappropriate. Methods: Four focus groups were undertaken, each on a different medication type (antibiotics, lipid-lowering agents, opioids and acetylcholinesterase inhibitors). Transcripts underwent qualitative analysis using line by line inductive coding and then a person-centred framework to highlight themes across medication types. Results: Sixteen participants participated in focus groups. Regardless of medication type or dilemma, results suggested decision-making for residents with advanced dementia should begin with discussing goals of care and engaging with families, and be viewed as an iterative process involving regular monitoring and adjustment. Decision-making was seen as requiring a dialectical approach involving multiple perspectives, with an emphasis on establishing communication between health professionals, family and the person with dementia to better understand goals/preferences for care. Conclusion: Inter-professional collaboration enables sharing of clinical experience/expertise, differing disciplinary perspectives and knowledge about the resident. Continuing a medication should be considered an active decision that carries as much responsibility as starting or deprescribing.

Original languageEnglish (US)
Pages (from-to)567-578
Number of pages12
JournalEuropean journal of clinical pharmacology
Volume76
Issue number4
DOIs
StatePublished - Apr 1 2020

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Keywords

  • Decision-making
  • Dementia
  • Deprescribing
  • Interdisciplinary collaboration
  • Long-term care
  • Potentially inappropriate prescribing

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

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