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).

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 were used to understand the various factors that contribute to the prescribing of PIMs and associated poor outcomes among residents living with frailty across LTC settings. Four medication classes were examined: antimicrobial, antipsychotics, cholinesterase inhibitors and anti-lipidemics.  A modified Delphi (consensus) panel was convened to explore opportunities to improve appropriate use of antimicrobials in LTC.

For more details on the project rationale, hypothesis, objectives and research plan, click here.

Publications, presentations and webinars

Project Team

Principal Investigators:

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

Co-Investigators:

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

SIG 2014-M1

Key words: elderly; long-term care; antimicrobial stewardship; interventions; pilot project

Publications

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).

Principal Investigators

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

Publications

Daneman N, Campitelli MA, Giannakeas V, Morris AM, Bell CM, Maxwell CJ, Jeffs L, Austin PC, Bronskill SE. CMAJ June 26, 2017 vol. 189 no. 25. Influences on the start, selection and duration of treatment with antibiotics in long-term care facilities. doi: 10.1503/cmaj.161437. Click here to view infographic.

Presentations

Mainville, M-C., Jeffs, L., Maione, M., Zahradnik, M., Morris, A., Bell, C., Bronskill, S., Maxwell, C. (September 2015). Frailty and recognizing appropriate medications in geriatrics and long term care (FRAMING-LTC): Protocol. 3rd Annual TVN Conference.

Stock, K., Hogan, D., Tyas, S., Bronskill, S., Morris, A., Bell, C.,
Jeffs, L., Ghandi, S., Maxwell, C. (September 2015). Frailty, drug use and hospitalization among older assisted living residents. 3rd Annual TVN Conference.

Stock, K., Hogan, D., Patten, S., Bronskill, S., Ghandi, S., Maxwell, C. (September 2015). The coexistence of frailty, dementia and depression in older adults. 3rd Annual TVN Conference.

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Rationale

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).

Principal Investigators

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

Rationale: 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 potentially inappropriate medications (PIM) or as an effect modifier of medication related adverse events this population.

Hypothesis: We hypothesize that frailty, PIM utilization and outcomes are interrelated.

Objectives: This mixed methods program of research will move beyond documenting variations in the quality of PIM prescribing and towards improving our understanding of the relationships between factors associated with prescribing decisions.

Research plan: We will use detailed resident-level clinical and functional data available from the Resident Assessment Instrument (RAI), and leverage opportunities to link this resource with population-based administrative health data for older LTC residents in Ontario and Saskatchewan. We will examine four medication classes: (1) antimicrobials, (2) antipsychotics, (3) cholinesterase inhibitors and (4) lipid-lowering medications. A series of interviews (healthcare providers, LTC residents, and family members), chart reviews, and examination of contextual factors resulting in prescribing decisions will also be examined.

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