Pilot Implementation of the Shed-MEDS Deprescribing Intervention for Persons With Dementia in Assisted Living Facilities

OBJECTIVES: A nurse practitioner (NP)-led intervention aimed to safely reduce the total number of medications and potentially inappropriate medications (PIMs) for persons living with dementia using the Shed-MEDS deprescribing protocol. DESIGN: Single-arm pilot intervention study in 2 memory care assisted living facilities (ALFs). METHODS: Residents aged 65 or older with a diagnosis of dementia and taking 5 or more medications or 1 PIM were eligible for participation. Surrogates provided consent and completed standardized assessments at enrollment and 90-day follow-up. Quality of life was measured via the proxy-rated Dementia Quality of Life Instrument. The study NP conducted a medication review via each participant's medication administration record to identify potential medications for deprescribing. Deprescribing recommendations were discussed with the participant's surrogate, and if the surrogate agreed, recommendations were shared with the primary prescriber to assess their agreement. After discussion with the primary prescriber, the study NP coordinated with the ALF medical team to finalize a deprescribing plan. RESULTS: Of 18 enrolled persons living with dementia, 16 completed the intervention and follow-up; the majority were female (64.7%) with a median age of 82 years. The median number of medications per participant at enrollment was 13, including 7 PIMs. The NP recommended, on average, 8 medications per participant for deprescribing, and surrogates agreed with 79% of recommendations. Prescribers agreed with 86% of shared deprescribing recommendations. By 90-day follow-up, there was a significant reduction in total medications (mean difference, 9) and a trend toward fewer PIMs (mean difference, 5.5), with an improvement in quality of life (94-104.5). CONCLUSIONS AND IMPLICATIONS: A pilot implementation of an NP-led deprescribing intervention in ALF memory care resulted in fewer medications and improvement in quality of life. A larger study is needed to evaluate the efficacy of NP-led deprescribing interventions in ALF memory care settings.