Grant: Project Grant

Multi-morbidity is the most common condition affecting older adults. As a result seniors in most countries now take around 7 medications daily. Death and illness rates from drug side effects in seniors are as high as those from many chronic diseases and affect falls, thinking, nutrition, fatigue and mobility. Taking 5 or more drugs ('polypharmacy') results in adverse drug effects requiring medical care affect in 13% of Canadian seniors: 1/3 are thought preventable. These are costly to those individuals, and costly to health systems. Canada's health care system lacks a systematic approach to minimizing these negative effects in routine care. We trialed a systematic method of patient centred reduction in medication burden in 70 seniors. This was safe, and the results suggested improvement in health and quality of life. We also tested the effect of discontinuation of single drugs in patients using over a long period to assess benefits and side effects and reviewed methods for asking patients with multiple conditions about their overall priorities for use of drug treatments, finding few tools that help incorporate these into research and clinical care. This program of research will develop these complimentary themes of generation of research evidence around drug discontinuation, and integration of patients' priorities for care. These will be drawn together in a new preventive framework for clinical care, aiming to minimize the harms of treatments in polypharmacy by patient centred discontinuation ('deprescribing'). We will test this intervention in large trials across Canada, assessing the important effects on patients and the healthcare system and will be using insights from patient's and prescriber's experiences of the process of drug discontinuation to provide tools for both. Our aim is to embed reduction of medication burden through medication review and 'deprescribing' as part of regular preventive care in older adults.