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MinMed: Do Older Adults do Better With Less Medication
Sponsor: University of Alberta
Summary
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.
Official title: MinMed: Do Fewer Medications, and Lower Medication Doses, Result in Better Health Outcomes for Those 80 Years of Age and Older
Key Details
Gender
All
Age Range
80 Years - Any
Study Type
INTERVENTIONAL
Enrollment
1800
Start Date
2022-07-28
Completion Date
2028-09-30
Last Updated
2026-01-09
Healthy Volunteers
Yes
Conditions
Interventions
Medication minimization
During the medication minimization visit, and any necessary follow-up visits, patients and providers work together to gradually minimize medication dosages (e.g. reducing 1/4 or 1/2 dose at a time) using the following approach: 1) Medications Treating Symptoms: Find the minimum dose that controls the symptom, 2) Drugs that Lower Blood Pressure: Reduce dosages until systolic BP is in the upper 10mmHg of the target range (e.g. target 130 - 140 mmHg), 3) Drugs That Lower Blood Sugar: Reduce dosages until HbA1c is in the upper 5% of the target range (e.g. target 7.5 - 8.0%).
Locations (1)
Kaye Edmonton Clinic Family Medicine Clinic
Edmonton, Alberta, Canada