Deprescribing Medications for Physical Function
Trial Summary
Will I have to stop taking my current medications?
The trial involves a plan to gradually reduce or stop certain medications that have sedative or anticholinergic effects, like antidepressants, benzodiazepines, or opioids. Participants will follow a deprescribing plan to lower their medication burden, so you may need to change your current medications.
What data supports the effectiveness of deprescribing anticholinergic and sedative medications for improving physical function?
Is deprescribing anticholinergic and sedative medications safe for older adults?
Deprescribing anticholinergic and sedative medications in older adults is generally considered safe and may improve health outcomes, but these medications have been linked to risks like falls, fractures, and cognitive issues. It's important to have healthcare providers guide the process to ensure safety.12678
How is deprescribing anticholinergic and sedative drugs unique?
Deprescribing anticholinergic and sedative drugs is unique because it focuses on reducing or stopping medications that may cause harm, especially in older adults, to improve their physical function and reduce side effects. This approach is patient-centered and often led by pharmacists, which is different from traditional treatments that typically involve adding medications rather than removing them.12359
What is the purpose of this trial?
Medications with sedative or anticholinergic effects such as antidepressants, benzodiazepines, or opioids have been associated with impaired cognitive and physical function. They are referred to as potentially inappropriate medications or medications that are best avoided by older adults. The accumulated evidence has now shifted the clinical and research focus to evaluating the who, what, and how of the best way to deprescribe (i.e., dose reduction or cessation of these medications). The Drug Burden Index (DBI) allows researchers and clinicians to quantify the cumulative burden of anticholinergic and sedative medications in each patient. Deprescribing these medications is a complex health intervention based on trade-offs between their clinical benefits (e.g., symptom management and prevention of diseases) and their adverse drug events to improve physical and cognitive function. Existing physical function performance metrics, such as gait speed captured in the clinic, are often non-specific and do not reflect real-life performance. Innovative mobility metrics are required to better understand specific deficits with age and disease and the effects of medications on these deficits.The goal of this project is to better characterize the impact of reducing the anticholinergic and sedative medication burden on physical function in older adults by novel mobility metrics in lab and real-life environments.A prospective, longitudinal cohort of 182 community-dwelling older adults (≥ 65 years) with a DBI of ≥ 1 will be completed. Using a quasi-experimental design, recruited patients will undergo a medication deprescribing plan, as part of usual clinical care, that includes three gradual changes to their medication regimen resulting in three DBI levels. At each DBI level, physical function mobility including dual-task tests) will be assessed in the lab with wearable sensors during validated clinical tests such as the Short Physical Performance Battery. Objective balance and mobility metrics (e.g., sway area and frequency, stride length) will be extracted. Physical function will also be assessed continuously in the patient's real-life environment from recruitment to the last lab visit, using wearable (Apple Watch® with ankle inertial measurement unit) and environmental sensors. Cognition will be measured using the Montreal Cognitive Assessment, Trail Making Test Part A \& B, and Digit Symbol Substitution Test.
Eligibility Criteria
This trial is for community-dwelling adults aged 65 or older who are currently taking medications with sedative or anticholinergic effects, and have a Drug Burden Index (DBI) score of at least 1. They must agree to a plan that reduces their DBI by at least 0.5. Those with dementia, reliance on walkers for mobility, or unstable medical conditions requiring recent hospital visits cannot participate.Inclusion Criteria
Exclusion Criteria
Timeline
Screening
Participants are screened for eligibility to participate in the trial
Deprescribing Plan
Participants undergo a medication deprescribing plan with three gradual changes to their medication regimen resulting in three DBI levels.
Assessment
Physical function mobility is assessed in the lab with wearable sensors during validated clinical tests such as the Short Physical Performance Battery.
Follow-up
Participants are monitored for safety and effectiveness after treatment
Treatment Details
Interventions
- Deprescribing anticholinergic and sedative medications
Find a Clinic Near You
Who Is Running the Clinical Trial?
Centre de recherche du Centre hospitalier universitaire de Sherbrooke
Lead Sponsor