FRAMING-LTC: Frailty and Recognizing Appropriate Medications IN Geriatrics and Long-Term Care

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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.

Andrew Morris, MD, SM, FRCP(C) is a Professor in the Department of Medicine, Division of Infectious Diseases, at the University of Toronto, and a consultant in Infectious Diseases and General Internal Medicine at Sinai Health System (SHS) and University Health Network (UHN). He is the Director of the SHS-UHN Antimicrobial Stewardship Program. He obtained his medical degree at the University of Toronto, where he also completed specialty certification in Internal Medicine and subspecialty certification in Infectious Diseases. Dr. Morris also completed a Master’s Degree in Epidemiology from the Harvard School of Public Health. His research interests are in the areas of infectious diseases, pharmacotherapy and antimicrobial stewardship.

Susan Bronskill, PhD is a Senior Scientist and Program Lead at ICES, Canada’s largest health services and policy research institute. Her research builds upon population-based administrative databases to study transitions between health care sectors. Dr. Bronskill’s research concentrates on improving quality of care, health services utilization and health care outcomes for older adults — including persons with Alzheimer’s and related dementias, women, and those who are frail. An additional focus of her research is optimizing medication use in community and long-term care settings. Dr. Bronskill holds appointments at the Dalla Lana School of Public Health, University of Toronto and has a strong record of grant funding including a Canadian Institutes of Health Research New Investigator Award in the Area of Aging.

Lianne Jeffs, MScN, PhD is Research and Innovation Lead Scholar in Residence and Senior Clinician Scientist with Lunenfeld-Tanenbaum Research Institute of Sinai Health System and an Affiliate Scientist in the Keenan Research Centre of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital. Her research program focuses on the network and organizational learning and system performance using integrated patient safety, quality improvement and knowledge translation approaches. Her academic credentials include a BScN and MSc from the Faculty of Nursing, University of Toronto, and a PhD from the Department of Health, Policy, Management and Evaluation at the Faculty of Medicine, University of Toronto.

Colleen Maxwell, PhD is a Professor and University Research Chair with the Schools of Pharmacy and Public Health & Health Systems, University of Waterloo, an Adjunct Scientist with the Institute for Clinical Evaluative Sciences (ICES), and an Adjunct Professor with Community Health Sciences, University of Calgary. She is a senior health services researcher with expertise in aging, frailty, continuing care and pharmacoepidemiology. Her research interests include the quality of care and pharmacotherapy of older vulnerable populations across the care continuum – particularly those with dementia, depression and related disorders. A key focus is the investigation of different approaches to screen for (and grade) levels of frailty among older adults with the goal of using this information to optimize geriatric pharmacotherapy and outcomes. She is involved in national and international collaborative research on the health, medication and quality of care needs of older residents within assisted living and long term care settings.