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Background: Sleep disturbance is a prevalent condition among people living with dementia (PLwD) or mild cognitive impairment (MCI). Its assessment and management within primary care is complex because of the comorbidities, older age, and cognitive impairment typical of this patient group. Aim: To explore how primary care clinicians assess, understand, and manage sleep disturbance for PLwD or MCI; if and why such initiatives work; and how people and their carers experience sleep disturbance and its treatment. Design and setting: A realist review of existing literature conducted in 2022. Method: Six bibliographic databases were searched. Context–mechanism–outcome configurations (CMOCs) were developed and refined. Results: In total, 60 records were included from 1869 retrieved hits and 19 CMOCs were developed. Low awareness of and confidence in the treatment of sleep disturbance among primary care clinicians and patients, combined with time and resource constraints, meant that identifying sleep disturbance was difficult and not prioritised. Medication was perceived by clinicians and patients as the primary management tool, resulting in inappropriate or long-term prescription. Rigid nursing routines in care homes were reportedly not conducive to good-quality sleep. Conclusion: In primary care, sleep disturbance among PLwD or MCI is not adequately addressed. Over-reliance on medication, underutilisation of non-pharmacological strategies, and inflexible care home routines were reported as a result of low confidence in sleep management and resource constraints. This does not constitute effective and person-centred care. Future work should consider ways to tailor the assessment and management of sleep disturbance to the needs of individuals and their informal carers without overstretching services. [ABSTRACT FROM AUTHOR]

Background: Medication review (MR) is the systematic assessment of a patient's medications for safety and effectiveness by a healthcare professional. The language used to describe MR activity, such as stopped medicine and increased dose, should be consistent across studies to assist researchers compare how different services operate and identify their mechanism of impact. Aim: To develop an international taxonomy of standardized terms and activity definitions related to medication reviews. Method: This was a three-stage Delphi-based consensus study with international medication review experts. A systematic review provided MR activity terms for the survey. Experts rated their consensus on each activity term and its definition on a Likert scale and provided written feedback. The consensus was 75% panel agreement. At each stage, consensus elements were retained, and feedback was used to revise definitions. Results: Seven experts were recruited for the study (response rate 15.2%) from four countries: the United Kingdom (n = 4), New Zealand (n = 1), Australia (n = 1), and Malaysia (n = 1). The following terms achieved consensus: the term Medication as a descriptor for MR terms; discontinue medication, start medication, dose increase, dose decrease, dosage form change, and medication safety and efficacy monitor to describe MR activity; Educate to describe the delivery of healthcare professionals and patients/carers education. Conclusion: Standardized medication review activity terms and definitions have been selected for universal adoption in all future MR research to facilitate a meaningful comparison of process evaluations within different settings. [ABSTRACT FROM AUTHOR]

This article discusses the problem of overprescribing medications to older adults and the lack of routine deprescribing practices. Deprescribing is a complex process that requires behavior change from healthcare professionals. The article emphasizes the need for interventions that address all key determinants of deprescribing and suggests using logic models to visually depict interventions and their effects. It also highlights the importance of understanding the context in which behavior change interventions are implemented and evaluating fidelity and outcomes. The article concludes by calling for consistency and adherence to a defined pathway for developing and evaluating complex interventions. [Extracted from the article]

Deprescribing is the process of stopping medication that may no longer be necessary or is causing harm. There has been a significant amount of research on deprescribing in the past decade, covering topics such as deprescribing rates, barriers and facilitators, and interventions. A group of deprescribing experts compiled a list of ten articles that provide a diverse overview of the field for newcomers. The articles cover critical concepts, high-level overviews, major trials, the complexity of deprescribing, and knowledge synthesis in deprescribing. While the list is not exhaustive, it serves as a starting point for those interested in learning about deprescribing. [Extracted from the article]

Aims: The Care Home Independent Pharmacist Prescriber Study (CHIPPS) process evaluation hypothesized that contextual factors influenced the likelihood of deprescribing by pharmacist-independent prescribers. The aim of this paper is to test this hypothesis. Methods: From CHIPPS study data, medications deprescribed totalled 284 for 370 residents in UK care homes. Regression analysis was used to describe the relationship between the number of medicines stopped and contextual factors (number of residents cared for, pharmacist employment within associated medical practice, previous care home experience, hours active within trial, years’ experience as a pharmacist and as a prescriber). Results: Number of residents and pharmacist-independent prescriber employment within a medical practice were positive predictors of deprescribing. Conclusion: Previous experiences were not related to deprescribing likelihood. Increasing the number of residents increases the opportunity for deprescribing and therefore this relationship is intuitive. The location within a medical practice is an interesting finding that requires further exploration to understand its exact nature. [ABSTRACT FROM AUTHOR]