University of Washington
Deprescribing to Reduce Injurious Falls among Older Adults with Dementia (STOP-FALLS-D)
Health Care Systems
Kaiser Permanente Washington
Benjamin Balderson, PhD, Site PI
Dr. Phelan is professor of gerontology and geriatric medicine at the University of Washington (UW) School of Medicine, adjunct professor of health systems and population health at UW School of Public Health, and affiliate investigator at Kaiser Permanente Washington Health Research Institute. She is director of the Northwest Geriatrics Workforce Enhancement Center and founding director of the UW Medicine Fall Prevention Clinic. She is a clinically active, board-certified geriatrician whose clinical work encompasses the inpatient and outpatient settings and involves teaching principles of internal medicine and geriatric medicine to students, residents, and fellows. Dr. Phelan's research aims to promote health and prevent functional decline in community dwelling older adults by improving quality of care for geriatric syndromes (falls, dementia). She worked closely with the Centers for Disease Control and Prevention (CDC) as their content expert to develop the STEADI (Stopping Elderly Accidents Deaths and Injuries) fall prevention toolkit for healthcare providers. Her research typically involves collaborative partnerships with healthcare and community organizations that serve older persons.
RATIONALE: Falls among older adults are a major public health concern, and older people living with dementia (PLWD) have disproportionately higher fall rates. The use of medications that affect the central nervous system (CNS) is a key modifiable risk factor for falls. CNS-active medications are often considered potentially inappropriate for older adults, especially for older PLWD, and guidelines recommend avoiding their use. However, use remains common and is higher among older PLWD compared to those without dementia. Few deprescribing interventions have targeted older PLWD in primary care.
OBJECTIVE: Adapt an evidence-based, health-system-embedded, patient-centered deprescribing intervention called STOP-FALLS, which focuses on reducing use of CNS-active medications among older adults living with dementia, and conduct a pilot study for an embedded pragmatic clinical trial (ePCT) with older PLWD, their care partner(s), and their primary care providers (PCPs).
SETTING: Kaiser Permanente Washington, an integrated healthcare delivery system in the Northwest United States.
POPULATION: Community-dwelling older PLWD, their care partners, and their PCPs.
INTERVENTION: Educational brochures for PLWD and their care partners and decision support for the PCPs.
OUTCOMES: The primary clinical outcome is medically treated falls. Secondary outcomes include: all-cause emergency department visits and hospitalizations, and nursing home placement. Implementation endpoints include: feasibility of reaching older PLWD and their care partners, acceptability of the intervention, and whether the intervention was implemented as intended.
IMPACT: Improving the quality of prescribing is imperative to reduce adverse outcomes and optimize quality of life for older PLWD. With the rapid growth in numbers of PLWD, effective strategies are urgently needed. STOP-FALLS–D will provide important new evidence about the feasibility of deprescribing CNS-active medications in partnership with PLWD, their care partner(s), and their primary care providers. This work will lay the foundation for a future large-scale ePCT.