NCT03202264

Team Approach to Polypharmacy Reduction to Improve Mobility Long-Term Care

Team Approach to Polypharmacy Reduction to Improve Mobility (TAPER-Mobility): A Pilot Feasibility Study in a Long-Term Care Setting

• Status: Terminated
• Phase: —
• Study type: Observational
• Enrollment: 30 (actual)
• Sponsor: McMaster University · Academic / Other
• Sex: All
• Age: 70 Years
• Healthy volunteers: Not accepted

Summary

Medication side effects and interactions between medications are very common in older adults and are related to negative health outcomes, including mobility. In this study, the investigators will test a new process aimed at reducing unnecessary medication use and drug side effects in seniors using the best medical evidence and patient preferences for treatment. This study will assess how feasible the implementation of this intervention is within a long-term care facility as well as if it is possible. The study will also assess for any signals of reversal of medications related mobility impairments to reduce medications-related mobility impairment (fatigue, pain, falls) using the intervention. Participants in two long-term care facilities will participate in this study. Measures will include feasibility outcomes regarding the logistics of the intervention as well as patients outcomes (falls, hospitalizations, and medications) collected before and after implementation. Findings will inform the design of a randomized controlled trial to test the effect of this intervention on health outcomes.

Detailed description

There are substantial associations between polypharmacy and reduced function from older adults and this is likely to be important in frail older adults both in long term care and in the community. The reversibility of drug-induced mobility impairment is unclear therefore the investigators plan to investigate signals of any impact of reducing polypharmacy on mobility. The investigators chose the long-term care setting given the presence of complete medication administration records and this patient population's high prevalence of polypharmacy and risk of adverse drug events. TAPERMD is an electronic tool for systematic medication reduction that incorporates patient priorities, electronic screening for potentially harmful medicines, supporting evidence tools and a monitoring pathway to support medication reduction. This study will examine the feasibility of this tool in a long-term care setting as well as examine. Participants in two long-term care facilities will participate in this study. Measures will include feasibility outcomes regarding the logistics of the intervention as well as patients outcomes (falls, hospitalizations, and medications) collected before and after implementation. Findings will inform a randomized controlled trial to measure the effect of this intervention on health outcomes.

Conditions

• Multi-morbidity
• Medication Therapy Management
• Polypharmacy

Interventions

Type	Name	Description
OTHER	TAPER	The intervention is medication reduction. This arm is comprised of: * Medication reconciliation * Identification of patient priorities for care * Identification of medications that are potentially appropriate for discontinuation/dose reduction * Linked pharmacist/family physician consultations with patient to discuss medication with intention to reduce * Identification of medications for trial of discontinuation/dose reduction (shared decision making) * Pause of medication and clinical monitoring

Timeline

• Start date: 2017-07-01
• Primary completion: 2019-11-13
• Completion: 2019-11-13
• First posted: 2017-06-28
• Last updated: 2021-09-08
• Results posted: 2021-09-08

Locations

1 site across 1 country: Canada