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

Study Overview
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Brief Summary
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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
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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.

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

Conditions
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Multi-morbidity, Medication Therapy Management, Polypharmacy

Intervention / Treatment
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* Other: TAPER


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: residing in 2 long-term care facilities in Brampton, ON on 5 or more medications 70 years of age or older adequate English language

Ages Eligible for Study
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Minimum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| TAPERMD<br>80 Long term care residents on 5 or more medications aged over 70 from 2 long term care facilities | Other: TAPER<br>* 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<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Successful Discontinuation (Difference in Mean Number of Medications; Reduction in Dose) | Difference in mean number of medications; number of medications reduced in dose | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mobility-related Fatigue | Avlund Mob-T Scale | Baseline, 6 months | 
| Level of Physical Functioning | Manty survey | Baseline, 6 Months | 
| Pain | Brief Pain Inventory | Baseline, 6 Months | 
| Falls | Total count of falls recorded in hospital admissions, primary care records and patient report | Baseline, 6 Months | 
| Sleep | Pittsburgh Sleep Quality Index | Baseline, 6 Months | 
| Decrease in Medication Side Effects and Symptoms | Patient self-report change in symptoms, side effects, health improvements and problems | 1-week, 3-month, 6-month | 
| Serious Adverse Events | Any event that requires in-patient hospitalization or prolongation of existing hospitalization, causes congenital malformation, results in persistent or significant disability or incapacity, is life-threatening or results in death (Health Canada (2011) Guidance Document for Industry - Reporting Adverse Reactions to Marketed Health Products) | 1-week, 3-month, 6-month | 
| Quality of Life | EQ5D-5L | Baseline, 6-months | 
| Physical Functioning Performance | Timed-up and go Test | Baseline, 6-months | 
| Physical Functioning Performance | Timed 8-foot walk test | Baseline, 6-months | 
| Performance of Activities of Daily Living | Barthel Index | Baseline, 6-months | 
| Strength | Hand grip | Baseline, 6-months | 
| Functional Ability | Functional ability scale for the elderly | Baseline, 6-months | 
| Healthcare Utilization | Cost of hospitalizations | Baseline, 6-months | 
| Healthcare Utilization | Count of Emergency room visits | Baseline, 6-months | 
| Healthcare Utilization | Number of clinic visits | Baseline, 6-months | 
| Feasibility Outcomes | Number of participants that refuse recruitment | 6 months | 
| Feasibility Outcomes | Retention rates | 6 months | 
| Feasibility Outcomes | number of canceled appointments | Baseline, 6 months | 
| Feasibility Outcomes | Time to complete measures | Baseline, 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Polypharmacy, Mobility, Multimorbidity, Drug Discontinuation, Patient Preference, eHealth