Caregiver perspectives on deprescribing medications in the care of older adults with dementia: a systematic review of qualitative studies

Older adults living with dementia often face polypharmacy and related risks. Caregivers play a vital but underrecognized role in managing medications and deprescribing decisions. This systematic review synthesizes qualitative research on caregiver experiences to inform practices that support shared decision-making and improve safe, person-centered medication management in dementia care. To identify qualitative studies of caregiver perspectives on deprescribing in dementia, seven databases (Embase, Medline, APA PsycINFO, CINAHL, Scopus, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews) were searched on September 25, 2023, and updated on November 18, 2024 to capture recent publications. References were also hand searched. Two reviewers screened, extracted, and appraised studies. Data were thematically analyzed, with triangulation and team consensus ensuring rigor, credibility, and depth in interpreting caregiver-reported experiences. Eight studies met inclusion criteria, spanning five countries and varied qualitative methods. These studies identified factors that influenced deprescribing at the levels of the person with dementia, the caregiver, the healthcare team, and the system. Caregivers often fear harms from stopping medications, lack understanding of alternatives, and feel unsupported during deprescribing. Trust, clear communication, and shared decision-making, especially as care goals shift, can empower caregivers to begin deprescribing conversations with clinicians.