Abstract
Summary
Little is known about caregivers’ perspectives on deprescribing bisphosphonates for older adults with dementia. Caregivers agreed that fracture prevention was important for maintaining functional independence but acknowledged that changing goals of care may justify deprescribing. Conversations grounded in “what matters most” can align fracture prevention treatment with goals of care.
Purpose
The long-term fracture prevention benefits of bisphosphonates may begin to be overshadowed by the potential burden of adverse effects and polypharmacy for older adults living with dementia as the disease progresses. We characterized factors that influence caregiver decision-making for continuing versus deprescribing bisphosphonates for persons living with dementia.
Methods
We conducted 11 interviews with family or informal caregivers of older adults living with dementia in the community or in long-term care who had been treated with bisphosphonates. Interviews focused on experiences caring for someone who has experienced a fracture, perceived benefits and harms of bisphosphonates, and experiences with deprescribing. Analyses were conducted using a qualitative framework methodology guided by the Health Belief Model.
Results
Most caregivers were male (n = 8), younger than 65 (n = 8) and were an adult child caregiver (n = 8). Three caregivers were Black and five were Latino/a. Attempts to maintain functional independence despite high likelihood of falls was frequently discussed as contributing to fracture risk, in this population. Many caregivers perceived fracture prevention treatment as important, while several noted that it may become less important near the end of life. Perceived benefits of fracture prevention treatment for persons with dementia included improved quality of life and maintaining independence. Although most indicated that bisphosphonates were well tolerated, gastrointestinal adverse effects, preference for fewer treatments, and dementia-related behaviors that interfere with medication administration may be reasons for deprescribing.
Conclusion
Conversations grounded in caregiver experiences and “what matters most” may help optimize fracture prevention treatment for older adults with dementia.
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Data availability
Available at reasonable request to the corresponding author.
Code availability
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Funding
Dr. Niznik is supported by a K08 award from the NIA K08AG071794.
Dr. Hanson is supported by NIA R01AG065394.
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Niznik, J., Kelley, C., Fasth, L. et al. Deprescribing bisphosphonates for older adults with dementia: perspectives of caregivers. Osteoporos Int 35, 589–598 (2024). https://doi.org/10.1007/s00198-023-06967-5
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DOI: https://doi.org/10.1007/s00198-023-06967-5