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 our elders to emergency departments.
Knowing recommended drug doses are lower in seniors, and knowing most adverse drug reactions are dose-related, we 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 and 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, we will compare early minimizers to those whose medicines have not yet changed using electronic health data routinely collected on all Albertans. If we find what many studies suggest, minimizing medications may prolong independence, reduce mortality and hospitalization, and improve quality of life.
MinMed has all approvals and pilot clinics in place and is looking for funding. It is hoped that the early pilot clinics will begin randomization at the end of 2021.
Ethics approval in-hand
Trial registration under construction