Improving Medication Therapy for Older Patients with Common Co-morbidities

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DESCRIPTION (provided by applicant): The overall goal is to improve the use of medications for older people with multiple medical disorders. Our first step will be to Identify the prevalence, type and severity of prescribing problems in older people with defined patterns of multiple co-morbidities ("morbidotypes") from databases of representative large groups of older men and women (Veterans Administration databases for older men and Nursing home database (s) for older and very old women and men). The next step will be to develop "potentially optimized prescribing (POP)" algorithms that would be predicted to result in fewer medications prescribed, fewer unwanted effects, and be appropriate and efficacious for the older patient. The development process will consider clinical practice guidelines for each disorder, pharmacologic properties and interactions of medications used for the disorders (pharmacokinetic and pharmacodynamic), and geriatric conditions (function, projected length of life, care for vulnerable elderly) that would modify the approach to treatment of the disorder. The proposed optimized therapeutic combinations will then be evaluated and modified by experts from medical disciplines of the practice guidelines, clinical pharmacology and pharmacy, geriatrics, and health care utilization. The potentially optimized regimens identified will be used to design a subsequent comparative effectiveness study of the optimized combinations and "usual" therapy. PUBLIC HEALTH RELEVANCE: Aging is often accompanied by increasing numbers of health-related diagnoses and increased use of medications. Consumption of multiple medications or "polypharmacy" puts the older patient at increased risk for drug interactions and hospitalizations due to drug-related problems. Better understanding of current medication problems and development of improved medication therapy regimens could greatly benefit the vast majority of older people, or others, with multiple medical problems.