In recent years, the medical community has grappled with the complex challenge of managing medication regimens for people living with dementia. A groundbreaking qualitative systematic review published in BMC Geriatrics in 2026 by Bates, Efstathiou, Sutton, and colleagues brings to light the nuanced perspectives of both healthcare professionals and family members on deprescribing preventive medications in this vulnerable population. This report provides critical insights into the multifaceted decision-making processes that surround the reduction or cessation of medications aimed at preventing future illness, emphasizing the intricate balance between therapeutic benefit, patient safety, and quality of life.
Dementia is a progressive neurodegenerative condition that impairs cognitive function, memory, and daily activities, often requiring complex and evolving medical care. Preventive medications—those prescribed not to treat symptoms but to forestall complications like cardiovascular events, stroke, or diabetes—can accumulate over time, leading to polypharmacy. Polypharmacy, in turn, raises risks of adverse drug reactions, drug interactions, and increased burden on patients and caregivers. Deprescribing, a systematic approach to tapering or stopping medications that may no longer be beneficial or might be harmful, emerges as a critical strategy in geriatric medicine. However, its implementation is fraught with emotional, ethical, and clinical challenges.
The study utilized a qualitative synthesis of multiple prior research efforts, focusing on interviews and discussions with healthcare professionals, including physicians, nurses, and pharmacists, alongside family members intimately involved in caregiving. The researchers isolated themes highlighting the tension between striving to do no harm and the hesitancy to alter long-standing therapeutic regimens. Healthcare professionals often find themselves navigating between clinical guidelines, emerging evidence, and individual patient needs while managing the expectations and fears of family caregivers.
One central revelation from the review was the intricate interplay between clinical decision-making and emotional dynamics. Family members frequently expressed apprehension regarding deprescribing, fearing that stopping preventive medications might hasten decline or cause immediate harm. This anxiety often stems from a limited understanding of medication mechanisms and the progressive nature of dementia itself. Healthcare providers, meanwhile, emphasized the importance of transparent communication and shared decision-making to build trust and alleviate concerns, although they acknowledged time constraints and fragmented healthcare systems as barriers.
Importantly, the research highlighted variations in healthcare providers’ approaches based on their professional roles and experiences. Physicians often focused on medical evidence and risk-benefit analyses, whereas nurses and pharmacists brought forward practical considerations such as medication management complexity and patient adherence. This multidisciplinary perspective underscores the necessity of collaborative care models in optimizing deprescribing protocols and ensuring they align with patients’ goals of care.
The review also sheds light on the ethical dimension embedded in deprescribing preventive medications. Deciding to discontinue a drug that could potentially prevent future ailments requires weighing uncertain benefits against probable risks within a limited life expectancy framework. This places immense responsibility on clinicians to integrate prognosis, patient autonomy, and quality of life considerations while navigating clinical ambiguity. The study advocates for enhanced training in communication skills and ethical reasoning as integral components of deprescribing initiatives.
One of the pivotal technical insights discussed in the review pertains to the pharmacokinetic and pharmacodynamic changes in people with dementia, which can alter drug metabolism and sensitivity. Aging-related renal and hepatic function decline, variations in receptor responsiveness, and the fragility of neural circuits contribute to unpredictable medication effects. Such factors endorse the rationale for periodic medication reviews and adjustment of preventive therapies to minimize adverse outcomes.
Another crucial technical aspect involves the identification of potentially inappropriate medications (PIMs) using validated tools such as the Beers Criteria and STOPP/START criteria. These tools assist clinicians in systematically assessing the risk profiles of medications, especially in polypharmacy contexts typical among elderly patients with dementia. Despite their utility, the review finds that these criteria are underutilized in real-world practice, primarily due to workflow limitations and lack of interdisciplinary coordination.
The role of emerging technologies also features prominently in the discussion. Electronic health records (EHRs) integrated with clinical decision support systems (CDSS) have the potential to flag high-risk medications and suggest deprescribing alternatives. However, clinicians reported limited access to such tools or inconsistent alerts, highlighting a technological gap that warrants attention. Future innovations could include AI-driven predictive analytics tailored to dementia patient cohorts, offering personalized deprescribing strategies.
From a psychosocial perspective, the study elucidates how family caregivers’ cultural background, health literacy, and personal beliefs influence their attitudes toward medication withdrawal. Some caregivers see medications as tangible evidence of active treatment and worry that stopping them might equate to giving up hope. This cultural dimension necessitates the development of tailored educational interventions that respectfully address beliefs and improve understanding of dementia progression and medication impact.
The systematic review also outlines facilitators and barriers to deprescribing. Facilitators included established therapeutic relationships, multidisciplinary team involvement, routine medication reviews, and the use of structured deprescribing protocols. Barriers highlighted were communication gaps, uncertainty about clinical outcomes, limited time during consultations, and the fragmented nature of community and institutional care settings. Addressing these barriers requires health policy reforms, resource allocation, and systemic integration of deprescribing frameworks into routine geriatric care.
Another significant insight relates to the concept of “prescribing inertia,” a phenomenon where medications remain unchanged due to habit, fear of negative outcomes, or lack of updated clinical information. Overcoming this inertia demands proactive engagement from healthcare professionals, supported by continuous education and feedback mechanisms. Encouragingly, some settings reported successful deprescribing outcomes following targeted quality improvement initiatives incorporating multidisciplinary team meetings and patient-centered care planning.
The authors also advocate for enhanced research into biomarkers and clinical indicators that could help predict which patients are likeliest to benefit from deprescribing preventive medications. Such precision medicine approaches could reduce uncertainty and support evidence-based decision-making. Moreover, longitudinal studies tracking cognitive and functional outcomes post-deprescribing are necessary to establish safety profiles and optimize timing and selection of drugs to be tapered.
In conclusion, this rigorous qualitative review underscores the necessity of a holistic, patient-centered approach to deprescribing preventive medication in people living with dementia. It is evident that balancing the risks and benefits of extensive medication regimens requires not only clinical acumen but also empathetic communication and collaboration among healthcare professionals, patients, and families. The study calls for systemic changes to support deprescribing practices, encompassing education, technology, policy, and cultural competence. As dementia prevalence rises worldwide, optimizing medication management through deprescribing will be integral to enhancing the quality of life for millions affected by this challenging condition.
Subject of Research: The perspectives of healthcare professionals and family members on deprescribing preventive medications in people living with dementia.
Article Title: The views of healthcare professionals and family members on deprescribing preventive medication in people living with dementia: a qualitative systematic review.
Article References:
Bates, C., Efstathiou, N., Sutton, C. et al. The views of healthcare professionals and family members on deprescribing preventive medication in people living with dementia: a qualitative systematic review. BMC Geriatr (2026). https://doi.org/10.1186/s12877-026-07480-0
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