Geriatric syndromes encompass age-related conditions such as drug-induced cognitive impairment, urinary incontinence, falls and polypharmacy. Highly stigmatized, but often reversible, these syndromes affect quality of life and healthy functioning in later life. The aim of my research program is to test the effectiveness of three new interventions on patient, health care provider, and health system behaviors to reduce geriatric syndromes. The international trial I am leading is the ERA-AGE funded "Dare to Age Well for Women" trial, being conducted across Canada, the UK and France. This pragmatic, cluster randomized trial among 1000 women aged 65 years and older seeks to empower women to improve healthy active life expectancy through a community-based continence promotion intervention that reduces falls and improves stigma-related social functioning. Partners on this project are the Public Health Agency of Canada, the Institut National de Santé Publique de Québec, Public Health England, and Santé Publique de la France.
The second randomized trial, D-PRESCRIBE, tests the effectiveness of targeting community-based pharmacists to reduce inappropriate prescriptions. One hundred pharmacists from the four major pharmacy chains in Quebec and 450 senior men and women will be included. The third project is a CIHR-funded Partnership for Health System Improvement Grant conducted in collaboration with Ministère de la Santé et des Services sociaux du Québec, Choosing Wisely Canada and the Canadian Primary Care Sentinel Surveillance Network. This project will develop and disseminate an interdisciplinary primary care strategy to promote safer medical therapies to older adults. The intervention combines deprescribing algorithms with the rhetoric required to initiate difficult conversations about tapering or stopping drugs.
In parallel to testing the primary care intervention in the trial, I am chairing a national stakeholder's group to establish the Canadian Deprescribing Network, which aims to promote the cost-effective substitution of non-pharmacologic treatments in lieu of harmful drugs.