title: Systems to identify potentially inappropriate prescribing in people with advanced dementia: a systematic review.
abstract: BACKGROUND
  Systems for identifying potentially inappropriate medications in older adults are not immediately transferrable to advanced dementia, where the management goal is palliation. The aim of the systematic review was to identify and synthesise published systems and make recommendations for identifying potentially inappropriate prescribing in advanced dementia.
  
  
  METHODS
  Studies were included if published in a peer-reviewed English language journal and concerned with identifying the appropriateness or otherwise of medications in advanced dementia or dementia and palliative care. The quality of each study was rated using the STrengthening the Reporting of OBservational studies in Epidemiology (STROBE) checklist. Synthesis was narrative due to heterogeneity among designs and measures. Medline (OVID), CINAHL, the Cochrane Database of Systematic Reviews (2005 - August 2014) and AMED were searched in October 2014. Reference lists of relevant reviews and included articles were searched manually.
  
  
  RESULTS
  Eight studies were included, all of which were scored a high quality using the STROBE checklist. Five studies used the same system developed by the Palliative Excellence in Alzheimer Care Efforts (PEACE) Program. One study used number of medications as an index, and two studies surveyed health professionals' opinions on appropriateness of specific medications in different clinical scenarios.
  
  
  CONCLUSIONS
  Future research is needed to develop and validate systems with clinical utility for improving safety and quality of prescribing in advanced dementia. Systems should account for individual clinical context and distinguish between deprescribing and initiation of medications.
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney (UTS), 235-253 Jones St, Ultimo, NSW, 2007, Australia. domenica.m.disalvo@student.uts.edu.au.
authors.forename: Domenica
authors.initials: D
authors.lastname: Disalvo
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney (UTS), 235-253 Jones St, Ultimo, NSW, 2007, Australia.
authors.forename: Tim
authors.initials: T
authors.lastname: Luckett
authors.affiliation: Centre for Cardiovascular and Chronic Care, Faculty of Health, University of Technology Sydney (UTS), 235-253 Jones St, Ultimo, NSW, 2007, Australia.|Ingham Institute of Applied Medical Research, Sydney, NSW, Australia.|HammondCare, Sydney, NSW, Australia.|South Western Sydney Clinical School, University of New South Wales (UNSW), Sydney, NSW, Australia.
authors.forename: Meera
authors.initials: M
authors.lastname: Agar
authors.affiliation: NSW Therapeutic Advisory Group, Sydney, NSW, Australia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Bennett
authors.affiliation: St Vincent's Hospital, Sydney, Australia.|School of Nursing, Johns Hopkins University (JHU), Baltimore, USA.
authors.forename: Patricia Mary
authors.initials: PM
authors.lastname: Davidson
mesh_terms: D000368:Aged; D057189:Checklist / Q000379:methods / Q000592:standards; D003704:Dementia / Q000188:drug therapy*; D011307:Drug Prescriptions / Q000592:standards*; D006801:Humans; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D054539:Medication Therapy Management / Q000458:organization & administration*; D000067561:Potentially Inappropriate Medication List; D058996:Quality Improvement
keywords: Dementia; Deprescribing; Inappropriate prescribing; Medication review; Palliative care; Polypharmacy