1800 Participants Needed

Medication Reduction for Aging

Age: 65+
Sex: Any
Trial Phase: Phase 4
Sponsor: University of Alberta
No Placebo GroupAll trial participants will receive the active study treatment (no placebo)
Prior Safety DataThis treatment has passed at least one previous human trial

Trial Summary

What is the purpose of this trial?

Many health care providers believe "less-is-more" for older adults, and evidence suggests minimizing certain medications might improve health outcomes. While this evidence focuses on specific medications believed potentially problematic for seniors, it is really adverse reactions to COMMON medications (e.g. medications lowering blood sugar or treating pain) that bring older adults to emergency departments. Knowing recommended drug doses are lower in seniors, and knowing most adverse drug reactions are dose-related, the investigators are organizing primary care providers (family physicians and nurse practitioners) to invite their patients 80 years and older on 6 or more medications to review with them whether some medications could be safely reduced. For drugs treating a symptom (e.g. heartburn), patients and providers will work together to find the lowest dose that provides the same benefit. For drugs that lower blood pressure or blood sugar, doses will be adjusted to keep blood pressure and blood sugar in the upper end of the target range, a range many providers feel to be safer for older adults. Each provider will invite half their eligible patients to a minimization visit at the start of the study, and invite the other half later - after the health effects of minimizing the early group's medications is assessed. To do this, investigators will compare early minimizers to those whose medicines have not yet changed using electronic health data routinely collected on all Albertans. We hypothesize that minimizing medications will prolong independence, reduce mortality and hospitalization, and improve quality of life. It is important to recognize that the intervention (reviewing all medications and determining the lowest effective doses) is already widely recommended as best practice when prescribing for older adults. Despite this however, such medication reviews only infrequently take place. In this study investigators hope to demonstrate that family physicians can minimize their own prescribing, and that organizing providers in a way that permits such reviews to take place can provide health benefits to patients.

Will I have to stop taking my current medications?

The trial involves reviewing your current medications to see if any can be safely reduced, but it doesn't specify that you must stop taking them completely. You and your healthcare provider will work together to find the lowest effective doses.

What data supports the effectiveness of the drug minimization treatment for older patients?

Research shows that reducing the number of unnecessary medications in older patients can lower the risk of harmful drug reactions and improve overall well-being. A framework for minimizing drug use has been proposed, which involves carefully reviewing and adjusting medications to ensure only essential drugs are used, potentially reducing hospital admissions and deaths related to inappropriate medication use.12345

Is medication reduction safe for older adults?

Reducing medications in older adults can be safe and beneficial, as it helps prevent adverse drug events (unwanted side effects) that are more common in this age group due to multiple medications and changes in how their bodies process drugs.678910

How does medication minimization differ from other treatments for aging?

Medication minimization is unique because it focuses on reducing the number of medications a person takes, which can help decrease side effects and lower costs. Unlike other treatments that add medications, this approach aims to simplify and streamline treatment, especially for those who are already responding well to their current regimen.1112131415

Research Team

SG

Scott Garrison, MD, PhD

Principal Investigator

University of Alberta

Eligibility Criteria

This trial is for individuals who are 80 years or older, take six or more long-term oral medications, see participating primary care providers regularly, and live independently (not in a nursing home). There are no specific exclusion criteria.

Inclusion Criteria

Community dwelling (i.e. not living in a nursing home or supportive living facility)
I am 80 years old or older.
Attached to participating primary care providers
See 1 more

Exclusion Criteria

Not applicable.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Medication Minimization

Participants have a dedicated medication minimization visit with their usual primary care provider to review and potentially reduce medication dosages.

6 months
1 visit (in-person) for medication review

Follow-up

Participants are monitored for safety and effectiveness after medication minimization.

18 months

Treatment Details

Interventions

  • Medication minimization
Trial Overview The study tests if reducing medication doses can benefit seniors. It involves reviewing patients' current medications to find the lowest effective doses for symptom relief and adjusting drugs that control blood pressure and sugar to safer levels.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Medication minimizationExperimental Treatment1 Intervention
Patients have a dedicated medication minimization visit with their usual primary care provider to which they bring all of their medications (a so-called "brown bag" medication review).
Group II: Usual CareActive Control1 Intervention
Patients will continue to receive care as appropriate but no dedicated visit to review and minimize medications will be organized as a result of the study. Medications are free to be minimized during the normal course of care should the need arise.

Find a Clinic Near You

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials
957
Recruited
437,000+

Findings from Research

Elderly individuals (over 65 years) make up 12% of the U.S. population but account for 33% of all prescription drug use, highlighting their significant medication consumption.
The risk of adverse drug reactions is notably higher in the elderly due to factors like decreased organ function, changes in how drugs are processed in the body, and the complexities of taking multiple medications (polypharmacy), emphasizing the need for careful management of their drug regimens.
Principles of drug therapy in geriatric patients.Sloan, RW.[2013]

References

Minimizing inappropriate medications in older populations: a 10-step conceptual framework. [2022]
Deprescribing for frail older people - Learning from the case of Mrs. Hansen. [2018]
Suboptimal prescribing in older inpatients and outpatients. [2022]
[Interventions to optimize pharmacologic treatment in hospitalized older adults: a systematic review]. [2021]
Managing medications in clinically complex elders: "There's got to be a happy medium". [2022]
Characterisation of Drug-Related Problems and Associated Factors at a Clinical Pharmacist Service-Naïve Hospital in Northern Sweden. [2022]
Principles of drug therapy in geriatric patients. [2013]
Adverse Drug Event Prevention and Detection in Older Emergency Department Patients. [2023]
GeriMedRisk, a telemedicine geriatric pharmacology consultation service to address adverse drug events in long-term care: a stepped-wedge cluster randomized feasibility trial protocol (ISRCTN17219647). [2022]
[Increased consumption of drugs among the elderly results in greater risk of problems]. [2013]
Predicting successful biologics tapering in patients with inflammatory arthritis: Secondary analyses based on the BIOlogical Dose OPTimisation (BIODOPT) trial. [2023]
Cost-effective Tapering Algorithm in Patients with Rheumatoid Arthritis: Combination of Multibiomarker Disease Activity Score and Autoantibody Status. [2020]
Biologic discontinuation strategies and outcomes in patients with rheumatoid arthritis. [2020]
Down-titration of biologics for the treatment of rheumatoid arthritis: a systematic literature review. [2022]
Tapering biologic DMARDs in rheumatoid arthritis. [2023]
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