Medication Reduction for Aging
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?
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
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
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Medication Minimization
Participants have a dedicated medication minimization visit with their usual primary care provider to review and potentially reduce medication dosages.
Follow-up
Participants are monitored for safety and effectiveness after medication minimization.
Treatment Details
Interventions
- Medication minimization
Find a Clinic Near You
Who Is Running the Clinical Trial?
University of Alberta
Lead Sponsor