Skip to main content

Main menu

  • HOME
  • ARTICLES
    • Current Issue
    • Abstracts In Press
    • Archives
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • Other Publications
    • abfm

User menu

Search

  • Advanced search
American Board of Family Medicine
  • Other Publications
    • abfm
American Board of Family Medicine

American Board of Family Medicine

Advanced Search

  • HOME
  • ARTICLES
    • Current Issue
    • Abstracts In Press
    • Archives
    • Special Issue Archive
    • Subject Collections
  • INFO FOR
    • Authors
    • Reviewers
    • Call For Papers
    • Subscribers
    • Advertisers
  • SUBMIT
    • Manuscript
    • Peer Review
  • ABOUT
    • The JABFM
    • The Editing Fellowship
    • Editorial Board
    • Indexing
    • Editors' Blog
  • CLASSIFIEDS
  • JABFM on Bluesky
  • JABFM On Facebook
  • JABFM On Twitter
  • JABFM On YouTube
Research ArticleOriginal Research

Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions

Ariel R. Green, Patricia Lee, Emily Reeve, Jennifer L. Wolff, Chi Chiung Grace Chen, Rachel Kruzan and Cynthia M. Boyd
The Journal of the American Board of Family Medicine May 2019, 32 (3) 383-391; DOI: https://doi.org/10.3122/jabfm.2019.03.180335
Ariel R. Green
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Patricia Lee
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
BA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Emily Reeve
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Jennifer L. Wolff
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
PhD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Chi Chiung Grace Chen
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
MD, MHS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Rachel Kruzan
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
MD
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Cynthia M. Boyd
From Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD (ARG, CMB); University of Illinois College of Medicine at Chicago, Chicago (PL); Kolling Institute of Medical Research, Northern Clinical School, Faculty of Medicine, The University of Sydney, Sydney, Australia (ER); Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD (JLW); Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine (CCGC); Johns Hopkins Community Physicians, Baltimore, MD (RK); Department of Health Policy and Management, Baltimore, Johns Hopkins University Bloomberg School of Public Health, MD (CMB).
MD, MPH
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • References
  • Info & Metrics
  • PDF
Loading

References

  1. 1.↵
    Alzheimer's Association. 2016 Alzheimer's disease facts and figures. Alzheimers Dement. 2016;12:459–509.
    OpenUrlCrossRefPubMed
  2. 2.↵
    1. Brauner DJ,
    2. Muir JC,
    3. Sachs GA
    . Treating nondementia illnesses in patients with dementia. JAMA 2000;283:3230–5.
    OpenUrlCrossRefPubMedWeb of Science
  3. 3.↵
    1. Lin PJ,
    2. Zhong Y,
    3. Fillit HM,
    4. Chen E,
    5. Neumann PJ
    . Medicare expenditures of individuals with Alzheimer's disease and related dementias or mild cognitive impairment before and after diagnosis. J Am Geriatr Soc 2016;64:1549–57.
    OpenUrl
  4. 4.↵
    1. Reeve E,
    2. Bell JS,
    3. Hilmer SN
    . Barriers to optimising prescribing and deprescribing in older adults with dementia: a narrative review. Curr Clin Pharmacol 2015;10:168–77.
    OpenUrlCrossRefPubMed
  5. 5.↵
    1. Lau DT,
    2. Mercaldo ND,
    3. Harris AT,
    4. Trittschuh E,
    5. Shega J,
    6. Weintraub S
    . Polypharmacy and potentially inappropriate medication use among community-dwelling elders with dementia. Alzheimer Dis Assoc Disord 2010;24:56–63.
    OpenUrlCrossRefPubMed
  6. 6.↵
    1. Johnell K
    . Inappropriate drug use in people with cognitive impairment and dementia: a systematic review. Curr Clin Pharmacol 2015;10:178–84.
    OpenUrlCrossRefPubMed
  7. 7.↵
    1. Palinkas LA,
    2. Horwitz SM,
    3. Green CA,
    4. Wisdom JP,
    5. Duan N,
    6. Hoagwood K
    . Purposeful sampling for qualitative data collection and analysis in mixed method implementation research. Adm Policy Ment Health 2015;42:533–44.
    OpenUrlCrossRefPubMed
  8. 8.↵
    1. Strauss AL
    1. Glaser BG
    . The discovery of grounded theory: strategies for qualitative research. In: Strauss AL, ed. Chicago (IL): Aldine Pub. Co.; 1967.
  9. 9.↵
    1. Strauss AL
    1. Corbin JM
    . Basics of qualitative research techniques and procedures for developing grounded theory. In: Strauss AL, ed. Los Angeles (CA), SAGE; 2008.
  10. 10.↵
    1. Kouladjian L,
    2. Gnjidic D,
    3. Reeve E,
    4. Chen TF,
    5. Hilmer SN
    . Health care practitioners' perspectives on deprescribing anticholinergic and sedative medications in older adults. Ann Pharmacother 2016;50:625–36.
    OpenUrlCrossRefPubMed
  11. 11.↵
    1. Ailabouni NJ,
    2. Nishtala PS,
    3. Mangin D,
    4. Tordoff JM
    . General practitioners' insight into deprescribing for the multimorbid older individual: a qualitative study. Int J Clin Pract 2016;70:261–76.
    OpenUrlPubMed
  12. 12.↵
    1. Anderson K,
    2. Stowasser D,
    3. Freeman C,
    4. Scott I
    . Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open 2014;4:e006544.
    OpenUrlAbstract/FREE Full Text
  13. 13.↵
    1. Cook JM,
    2. Marshall R,
    3. Masci C,
    4. Coyne JC
    . Physicians' perspectives on prescribing benzodiazepines for older adults: a qualitative study. J Gen Intern Med 2007;22:303–7.
    OpenUrlCrossRefPubMedWeb of Science
  14. 14.↵
    1. Croskerry P
    . The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med 2003;78:775–80.
    OpenUrlCrossRefPubMedWeb of Science
  15. 15.↵
    1. Gurwitz JH
    . The physics of geriatric pharmacotherapy: overcoming therapeutic inertia and momentum. Am J Med 2012;125:523–4.
    OpenUrlCrossRefPubMed
  16. 16.↵
    American Diabetes Association. 11. Older adults: standards of med care in diabetes-2018. Diabetes Care. 2018;41:S119–S25.
    OpenUrlAbstract/FREE Full Text
  17. 17.↵
    1. Schuling J,
    2. Gebben H,
    3. Veehof LJ,
    4. Haaijer-Ruskamp FM
    . Deprescribing medication in very elderly patients with multimorbidity: the view of Dutch GPs. A qualitative study. BMC Fam Pract 2012;13:56.
    OpenUrlCrossRefPubMed
  18. 18.↵
    1. Palagyi A,
    2. Keay L,
    3. Harper J,
    4. Potter J,
    5. Lindley RI
    . Barricades and brickwalls–a qualitative study exploring perceptions of medication use and deprescribing in long-term care. BMC Geriatr 2016;16:15.
    OpenUrl
  19. 19.↵
    1. Turner JP,
    2. Edwards S,
    3. Stanners M,
    4. Shakib S,
    5. Bell JS
    . What factors are important for deprescribing in Australian long-term care facilities? Perspectives of residents and health professionals. BMJ Open 2016;6:e009781.
    OpenUrlAbstract/FREE Full Text
  20. 20.↵
    1. Holmes HM,
    2. Hayley D,
    3. Alexander G,
    4. Sachs GA
    . Reconsidering medication appropriateness for patients late in life. Arch Intern Med 2006;166:605–9.
    OpenUrlCrossRefPubMedWeb of Science
  21. 21.↵
    1. Narayan SW,
    2. Nishtala PS
    . Discontinuation of preventive medicines in older people with limited life expectancy: a systematic review. Drugs Aging 2017;34:767–76.
    OpenUrl
  22. 22.↵
    1. Parsons C,
    2. Hughes CM,
    3. Passmore AP,
    4. Lapane KL
    . Withholding, discontinuing and withdrawing medications in dementia patients at the end of life: a neglected problem in the disadvantaged dying? Drugs Aging 2010;27:435–49.
    OpenUrlCrossRefPubMedWeb of Science
  23. 23.↵
    1. Zulman DM,
    2. Sussman JB,
    3. Chen X,
    4. Cigolle CT,
    5. Blaum CS,
    6. Hayward RA
    . Examining the evidence: a systematic review of the inclusion and analysis of older adults in randomized controlled trials. J Gen Intern Med 2011;26:783–90.
    OpenUrlCrossRefPubMed
  24. 24.↵
    1. Zanetti O,
    2. Solerte SB,
    3. Cantoni F
    . Life expectancy in Alzheimer's disease (AD). Arch Gerontol Geriatr 2009;49:237–243.
    OpenUrlPubMedWeb of Science
  25. 25.↵
    1. Boyd CM,
    2. Darer J,
    3. Boult C,
    4. Fried LP,
    5. Boult L,
    6. Wu AW
    . Clinical practice guidelines and quality of care for older patients with multiple comorbid diseases: implications for pay for performance. JAMA 2005;294:716–24.
    OpenUrlCrossRefPubMedWeb of Science
  26. 26.↵
    1. Whelton PK,
    2. Carey RM,
    3. Aronow WS,
    4. et al
    . 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults. A report of the american college of cardiology/american heart association task force on clinical practice guidelines. Hypertension 2018;71:e127–e248.
    OpenUrl
  27. 27.↵
    1. Poudel A,
    2. Yates P,
    3. Rowett D,
    4. Nissen LM
    . Use of preventive medication in patients with limited life expectancy: a systematic review. J Pain Symptom Manage 2017;53:1097–1110.e1091.
    OpenUrl
  28. 28.↵
    1. Page AT,
    2. Clifford RM,
    3. Potter K,
    4. et al
    . Exploring the enablers and barriers to implementing the Medication Appropriateness Tool for Comorbid Health conditions during Dementia (MATCH-D) criteria in Australia: a qualitative study. BMJ Open 2017;7:e017906.
    OpenUrlAbstract/FREE Full Text
  29. 29.↵
    1. Smith F,
    2. Grijseels MS,
    3. Ryan P,
    4. Tobiansky R
    . Assisting people with dementia with their medicines: experiences of family carers. Int J Pharm Pract 2015;23:44–51.
    OpenUrl
  30. 30.↵
    1. Wolff JL,
    2. Spillman BC,
    3. Freedman VA,
    4. Kasper JD
    . A national profile of family and unpaid caregivers who assist older adults with health care activities. JAMA Intern Med 2016;176:372–9.
    OpenUrl
  31. 31.↵
    1. Kasper JD,
    2. Freedman VA,
    3. Spillman BC,
    4. Wolff JL
    . The disproportionate impact of dementia on family and unpaid caregiving to older adults. Health Aff (Millwood) 2015;34:1642–9.
    OpenUrlAbstract/FREE Full Text
  32. 32.↵
    1. Reinhard SC,
    2. Levine C,
    3. Samis S
    . Home alone: family caregivers providing complex chronic care. Washington, D.C., AARP; 2012.
  33. 33.↵
    1. Gitlin LN,
    2. Kales HC,
    3. Lyketsos CG
    . Nonpharmacologic management of behavioral symptoms in dementia. JAMA 2012;308:2020–9.
    OpenUrlCrossRefPubMedWeb of Science
  34. 34.↵
    1. Callahan CM,
    2. Boustani MA,
    3. Unverzagt FW,
    4. et al
    . Effectiveness of collaborative care for older adults with Alzheimer disease in primary care: a randomized controlled trial. JAMA 2006;295:2148–57.
    OpenUrlCrossRefPubMedWeb of Science
  35. 35.↵
    1. Jennings LA,
    2. Tan Z,
    3. Wenger NS,
    4. et al
    . Quality of care provided by a comprehensive dementia care comanagement program. J Am Geriatr Soc 2016;64:1724–30.
    OpenUrl
  36. 36.↵
    1. Bass DM,
    2. Judge KS,
    3. Snow AL,
    4. et al
    . Caregiver outcomes of partners in dementia care: effect of a care coordination program for veterans with dementia and their family members and friends. J Am Geriatr Soc 2013;61:1377–86.
    OpenUrlCrossRefPubMed
  37. 37.↵
    1. Kerns JW,
    2. Winter JD,
    3. Winter KM,
    4. Kerns CC,
    5. Etz RS
    . Caregiver perspectives about using antipsychotics and other medications for symptoms of dementia. Gerontologist. 2018;58:e35–e45.
    OpenUrl
  38. 38.↵
    1. Reeve E,
    2. Low LF,
    3. Hilmer SN
    . Beliefs and attitudes of older adults and carers about deprescribing of medications: a qualitative focus group study. Br J Gen Pract 2016;66:e552–560.
    OpenUrlAbstract/FREE Full Text
  39. 39.↵
    1. Moen J,
    2. Bohm A,
    3. Tillenius T,
    4. Antonov K,
    5. Nilsson JL,
    6. Ring L
    . “I don't know how many of these [medicines] are necessary.” - a focus group study among elderly users of multiple medicines. Patient Educ Couns 2009;74:135–41.
    OpenUrlCrossRefPubMedWeb of Science
  40. 40.↵
    1. Fagerlin A,
    2. Zikmund-Fisher BJ,
    3. Ubel PA
    . Helping patients decide: ten steps to better risk communication. J Natl Cancer Inst 2011;103:1436–43.
    OpenUrlCrossRefPubMedWeb of Science
  41. 41.↵
    1. Farrell B,
    2. Black C,
    3. Thompson W,
    4. et al
    . Deprescribing antihyperglycemic agents in older persons: evidence-based clinical practice guideline. Can Fam Physician 2017;63:832–43.
    OpenUrlAbstract/FREE Full Text
  42. 42.↵
    1. Jennings AA,
    2. Boyle S,
    3. Foley T
    . The development and evaluation of an online dementia resource for primary care based health professionals. Internet Interv 2018;11:47–52.
    OpenUrl
  43. 43.↵
    1. Page AT,
    2. Potter K,
    3. Clifford R,
    4. McLachlan AJ,
    5. Etherton-Beer C
    . Medication appropriateness tool for co-morbid health conditions in dementia: consensus recommendations from a multidisciplinary expert panel. Intern Med J 2016;46:1189–97.
    OpenUrl
  44. 44.↵
    1. Nagykaldi ZJ,
    2. Tange H,
    3. De Maeseneer J
    . Moving from problem-oriented to goal-directed health records. Ann Fam Med 2018;16:155–9.
    OpenUrlAbstract/FREE Full Text
PreviousNext
Back to top

In this issue

The Journal of the American Board of Family     Medicine: 32 (3)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 3
May-June 2019
  • Table of Contents
  • Table of Contents (PDF)
  • Cover (PDF)
  • Index by author
  • Back Matter (PDF)
  • Front Matter (PDF)
Print
Download PDF
Article Alerts
Sign In to Email Alerts with your Email Address
Email Article

Thank you for your interest in spreading the word on American Board of Family Medicine.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions
(Your Name) has sent you a message from American Board of Family Medicine
(Your Name) thought you would like to see the American Board of Family Medicine web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
3 + 1 =
Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.
Citation Tools
Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions
Ariel R. Green, Patricia Lee, Emily Reeve, Jennifer L. Wolff, Chi Chiung Grace Chen, Rachel Kruzan, Cynthia M. Boyd
The Journal of the American Board of Family Medicine May 2019, 32 (3) 383-391; DOI: 10.3122/jabfm.2019.03.180335

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Clinicians' Perspectives on Barriers and Enablers of Optimal Prescribing in Patients with Dementia and Coexisting Conditions
Ariel R. Green, Patricia Lee, Emily Reeve, Jennifer L. Wolff, Chi Chiung Grace Chen, Rachel Kruzan, Cynthia M. Boyd
The Journal of the American Board of Family Medicine May 2019, 32 (3) 383-391; DOI: 10.3122/jabfm.2019.03.180335
Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Methods
    • Results
    • Discussion
    • Conclusions
    • Appendix. Interview Guide for Primary Care Providers and Specialists
    • Notes
    • References
  • Figures & Data
  • References
  • Info & Metrics
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • Barriers and facilitators to deprescribing of cardiovascular medications: a systematic review
  • Barriers and facilitators of successful deprescribing as described by older patients living with frailty, their informal carers and clinicians: a qualitative interview study
  • Barriers and facilitators to deprescribing in primary care: a systematic review
  • Family Medicine: Data Driven Practice with Emphasis on Underserved Patients
  • Google Scholar

More in this TOC Section

  • Identifying and Addressing Social Determinants of Health with an Electronic Health Record
  • Integrating Adverse Childhood Experiences and Social Risks Screening in Adult Primary Care
  • A Pilot Comparison of Clinical Data Collection Methods Using Paper, Electronic Health Record Prompt, and a Smartphone Application
Show more Original Research

Similar Articles

Keywords

  • Adverse Decision Making
  • Drug Reaction
  • Comorbidity
  • Dementia
  • Geriatrics
  • Polypharmacy
  • Potentially Inappropriate Medications
  • Primary Health Care
  • Qualitative Research
  • Risk Assessment

Navigate

  • Home
  • Current Issue
  • Past Issues

Authors & Reviewers

  • Info For Authors
  • Info For Reviewers
  • Submit A Manuscript/Review

Other Services

  • Get Email Alerts
  • Classifieds
  • Reprints and Permissions

Other Resources

  • Forms
  • Contact Us
  • ABFM News

© 2025 American Board of Family Medicine

Powered by HighWire