Intervention
dementia
This study implemented an enhanced OptimaMed approach as compared to the pilot study [The documents for the MRG tool (Additional file 
and there is a list of specific medications used in NHs in the healthcare network at:
The second enhancement concerned the auditory for the KE session, that took place within 6 weeks after the study start date at each intervention NH. It now also addressed auxiliary nurses and orderlies, in addition to GPs, pharmacists and nurses who were present in the pilot study, given that these staff can be influential in the decision to initiate, increase or maintain certain medications, such as antipsychotics. Staff were invited to the training session by the NH management during their regular work shift, but participation remained voluntary. The KE session was animated by the research team, which presented a short introduction on study background, followed by a case vignette, presenting the MRG tool, the medication list, the tapering algorithm, and other published tools. This part was presented by a geriatrician (M Morin) with extensive experience in Continuous Education. During and after the case vignette, questions, answers, and comments were encouraged and an exchange took place. The session informed staff of the study rationale, the complexity of prescribing for seniors with severe dementia (e.g. metabolic changes, polypharmacy, frailty, etc.) and provided strategies aimed at optimizing specific medication regimens, such as less stringent targets for blood pressure or glycaemia [A primary medication regimen review was conducted shortly after the study start date by each NH pharmacist for each participating resident in the intervention NHs. Other reviews could be performed, on an as-needed basis, following changes in the resident’s clinical status. The pharmacotherapy-related suggested modifications were discussed with the resident’s nurse and GP. The decision to adjust medications was ultimately left to the clinical judgement of each GP, be it to increase doses or to deprescribe (i.e., tapering or stopping), with no interference from the research team. Meetings with family members were also conducted, in person, or as over the telephone meetings, for both intervention and control group participants, mostly related to the family care-giver’s consent for his/her family members’s participation. These meetings allowed to explore their thoughts about the appropriate use of medications.