FRAMING-LTC: Frailty and Recognizing Appropriate Medications IN Geriatrics and Long-Term Care
The results of the study will assist in designing pilot interventions aimed at improving the quality of pharmacotherapy and health outcomes for vulnerable populations in long-term care (LTC).
Possible Research Results
Anticipated findings: Through synthesis of study evidence we will be able to identify national and international applications for our findings, which include: (1) identifying possible pilot interventions at the resident, provider and LTC facility levels and (2) relating possible applications of population-based data at a policy level (i.e. the development of national quality indicators, standards of care).
Impact of findings: This study is an opportunity to use the lens of frailty as a conceptualized state to examine potentially inappropriate medication (PIM) use in LTC residents in the short term (i.e. antimicrobials) and long-term (e.g. antipsychotics, statins). This represents a novel framework for this issue, combines disparate medication groups in a unifying theme, and will provide a springboard from which to develop policy- and practice-interventions of national importance.
Publications, presentations and webinars
About the Project
Older adults in LTC often have multiple chronic conditions that increase their exposure to multiple medications. This places them at risk for PIM use, adverse events and high health care utilization. Optimal prescribing for vulnerable older populations, particularly those in LTC, may be influenced by various system, provider, individual and caregiver factors, and represents a key quality-of-care concern. There is a lack of empirical data in this area, and thus our understanding of the relative benefits, harms and economic implications posed by select medications commonly prescribed in LTC remains inadequate and underdeveloped.
The concept of frailty offers a promising avenue for identifying older adults who may be less able to tolerate or benefit from high risk medications and may require an alternative approach to their care. Frailty has been relatively unexplored as a predictor of exposure to PIMs or as an effect modifier of medication-related adverse events in vulnerable populations. Quantitative and qualitative approaches will be used to understand the various factors that contribute to the prescribing of PIMs and associated poor outcomes among frail residents across LTC settings. Four medication classes will be examined: antimicrobial, antipsychotics, cholinesterase inhibitors and anti-lipidemics.
For more details on the project rationale, hypothesis, objectives and research plan, click here.
Andrew Morris, MD, SM, FRCP(C) -- Sinai Health System
Chaim Bell, MD, PhD -- Sinai Health System
Susan Bronskill, PhD -- Institute for Clinical Evaluative Sciences
Lianne Jeffs, MScN, PhD -- St. Michael's Hospital
Colleen Maxwell, BSc, MA, PhD -- University of Waterloo
Joseph Amuah, PhD -- Canadian Institute for Health Information
Nick Daneman, MD, MSc -- Sunnybrook Health Sciences Centre
Sudeep Gill, MD, MSc -- Queen's University/Providence Care
Andrea Gruneir, PhD -- University of Alberta
David Hogan, PhD -- University of Calgary
Sylvia Hyland, MHSc -- Institute for Safe Medication Practices Canada
Madelyn Law, PhD -- Brock University
Jacques Lee, MD, FRCPC, MSc -- Sunnybrook Health Sciences Centre
Mark Loeb, MD, MSc -- McMaster University
Jonathan Mitchell, BSc, MSc -- Accreditation Canada
Kieran Moore, MD, CCFP(EM), FCFP, MPLc, MPH, MSc(DM), DTM&H, FRCPC -- KFL&A Public Health, Ontario
Scott Patten, MD, PhD -- University of Calgary
Jeff Powis, MD, MSc -- University of Toronto
Daniel Ricciuto, MD -- Lakeridge Health
Dallas Seitz, MD, PhD -- Queen's University/Providence Care
Samir Sinha, MD, DPhil, FRCPC -- Sinai Health System/University Health Network
Gary Teare, PhD -- Health Quality Council, Saskatchewan
Kednapa Thavorn, PhD -- Ottawa Hospital Research Institute
Walter Wodchis, PhD -- University of Toronto
Project Contact: Andrew Morris -- andrew.morris@sinaihealthsystem
Key words: elderly; long-term care; antimicrobial stewardship; interventions; pilot project