Researchers from the Colleges of Pharmacy and Public Health have received a $3 million grant from the Centers for Disease Control and Prevention (CDC) to conduct a four-year study examining falls of elderly people. The goal of the study, called the Medication Empowerment and Deprescribing for Safety (MEDS), is to see if the elimination of high-risk medications will reduce falls among the elderly.
“Falls are a leading cause of unintentional injury among older adults in the United States and Iowa,” said College of Pharmacy Assistant Professor Korey Kennelty, a co-principal investigator for the study. “Certain medications, including many that affect the central nervous system, increase the risk of an older adult experiencing a fall. We know these high-risk medications should be discontinued in our older patients, but how to do it is unclear. Our study will address that.”
Kennelty and other team members are currently setting up a pilot study that will focus on 50 older adult patients (65 years and older) from two rural medical clinics in Iowa. The purpose of the pilot is to test study workflows and processes, including the effectiveness of documents that will be used to educate and inform medical professionals and study patients. The pilot study is scheduled to kick off in the fall.
Other pharmacy team members are Jeffrey Reist, clinical associate professor; Michelle (Shellie) Fravel, clinical associate professor; and Ashley Dohrn, clinical pharmacy specialist. All team members work in the Department of Pharmacy Practice and Science. Kennelty is co-principal investigator with Carri Casteel, an associate professor in the UI College of Public Health.
The full-scale study will begin recruiting participants in 2020 and will involve 780 study patients from 23 rural primary care clinics in central and western Iowa. Working with medical teams at MercyOne health clinics, the pharmacy team will develop and implement patient-centered care plans to discontinue certain high-risk medications taken by older adult patients. Half of the 780 study patients will receive these care plans to discontinue high-risk medications and the other half will continue with their usual care.
Medications of particular interest are those that research has shown place older adults at more risk for falls, said Kennelty. These medications include opioids, benzodiazepines, and anticholinergics (e.g., antihistamines). Some elderly people take doses of these medications that are too high, she said, and a majority of them don’t even need to take the medications at all and should be weaned off of them as soon as possible.
“As pharmacists, a goal of ours is to empower older adults to get off these medications altogether,” said Kennelty. “There are a variety of reasons why they take them in the first place. Sometimes these medications are prescribed for a short-term period, but, for whatever reason, continue to be prescribed and so the patient becomes dependent upon them.”
The pharmacy team will work remotely from Iowa City with on-site clinic providers, nurses, and study patients to decrease dosages over time, said Kennelty. The pharmacists will communicate with the clinics, which are part of a network of critical-access hospitals in Iowa, via telephone and computer. Most of these smaller clinics do not have a sufficient budget to hire large staffs or certain categories of medical professionals, including pharmacists.
A second prong of the study will be to track automobile accidents of study participants.
“This study will resonate with a lot of people because so many of us have an elderly loved one who has suffered a fall or automobile accident,” said Kennelty. “I think we all know how a fall or an automobile accident can impact an elderly person’s life. It can mean a loss of independence that can have serious ramifications on the person’s outlook and overall health. I am confident we can have a real impact with this study.”