Introduction
dementia, cognitive impairment
DRUG INTERACTIONS, ADVERSE DRUG EVENTS, ADVERSE EFFECTS
Deprescribing has been defined in several studiesFurther, these ethical dilemmas related to optimal prescribing arise ubiquitously for clinicians treating people living with dementia who are particularly vulnerable to serious harm from polypharmacy (adverse drug events or drug interactions), treatment burden, and cognitive changes from adverse effects.Clinicians have little evidence to guide deprescribing decisions due to a clinical research culture focused on generating evidence to inform treatment intensification and methodologic limitations to conducting deprescribing investigations at scale. Without guidelines, clinicians may feel alone in their decision-making and have expressed reservations about stopping or reducing medicines. Articulated areas of uncertainty include changing medications started by other clinicians and having insufficient evidence on tapering and stopping medications.Understanding the influences on clinician decision-making in the context of potential ethical tensions and patient-centered pragmatic decision-making may help prepare clinicians for deprescribing discussions with their patients. In addition, understanding common deprescribing practices may inform the research agenda and support clinicians in undertaking thoughtful deprescribing until a formal evidence base becomes available.This study aimed to understand influences on physician deprescribing decision-making. To help guide development of deprescribing guidance and clinician education, we surveyed a national sample of primary care physicians who care for older adults (aged ≥65 years) on perceived influences affecting their deprescribing decisions for persons with cognitive impairment.