- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT05735379
Impact in Older Adults of Reducing Anticholinergic and Sedative Rx Burden on Physical Function Measured by Wearables
Impact in Older Adults of Reducing Anticholinergic and Sedative Medication Burden on Physical Function Measured by Clinical Digital Phenotyping in Lab and Real-life Environments
Medications with sedative or anticholinergic effects such as antidepressants, benzodiazepines, or opioids have been associated with impaired cognitive and physical function. They are referred to as potentially inappropriate medications or medications that are best avoided by older adults. The accumulated evidence has now shifted the clinical and research focus to evaluating the who, what, and how of the best way to deprescribe (i.e., dose reduction or cessation of these medications). The Drug Burden Index (DBI) allows researchers and clinicians to quantify the cumulative burden of anticholinergic and sedative medications in each patient. Deprescribing these medications is a complex health intervention based on trade-offs between their clinical benefits (e.g., symptom management and prevention of diseases) and their adverse drug events to improve physical and cognitive function. Existing physical function performance metrics, such as gait speed captured in the clinic, are often non-specific and do not reflect real-life performance. Innovative mobility metrics are required to better understand specific deficits with age and disease and the effects of medications on these deficits.
The goal of this project is to better characterize the impact of reducing the anticholinergic and sedative medication burden on physical function in older adults by novel mobility metrics in lab and real-life environments.
A prospective, longitudinal cohort of 182 community-dwelling older adults (≥ 65 years) with a DBI of ≥ 1 will be completed. Using a quasi-experimental design, recruited patients will undergo a medication deprescribing plan, as part of usual clinical care, that includes three gradual changes to their medication regimen resulting in three DBI levels. At each DBI level, physical function mobility including dual-task tests) will be assessed in the lab with wearable sensors during validated clinical tests such as the Short Physical Performance Battery. Objective balance and mobility metrics (e.g., sway area and frequency, stride length) will be extracted. Physical function will also be assessed continuously in the patient's real-life environment from recruitment to the last lab visit, using wearable (Apple Watch® with ankle inertial measurement unit) and environmental sensors. Cognition will be measured using the Montreal Cognitive Assessment, Trail Making Test Part A & B, and Digit Symbol Substitution Test.
Study Overview
Status
Intervention / Treatment
Study Type
Enrollment (Estimated)
Phase
- Phase 4
Contacts and Locations
Study Contact
- Name: Marilyn Tousignant, MSc
- Phone Number: 819-780-2222
- Email: marilyn.tousignant@usherbrooke.ca
Study Locations
-
-
Quebec
-
Sherbrooke, Quebec, Canada, J1H 4C4
- Recruiting
- CIUSSS de l'Estrie-CHUS
-
Contact:
- Marilyn Tousignant
-
-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- 65 years and older
- community-dwelling
- Drug Burden Index score of ≥ 1
- Agree with a deprescribing plan targeting a reduction in Drug Burden Index score of ≥ 0.5.
Exclusion Criteria:
- Dementia
- Need of a walker as a mobility assistive device
- Unstable medical condition (≥ 1 unplanned hospitalization or ≥ 2 emergency department visits in the past month).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: N/A
- Interventional Model: Single Group Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Deprescribing anticholinergic and sedative medications
Deprescribing plan targeting a reduction in drug burden index score of ≥ 0.5
|
Deprescribing plan targeting a reduction in Drug Burden Index score of ≥ 0.5
Other Names:
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in gait capacity measured in the lab from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Gait speed (m/s)
|
Through study completion, an average of 4 months.
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in gait performance measured in real-life settings from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Gait activity (number of steps)
|
Through study completion, an average of 4 months.
|
Change in functional limitations and disability from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Late-Life Function and Disability Instrument (Late-Life FDI),
|
Through study completion, an average of 4 months.
|
Change in caregiver report of the patients' functional status from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Older Adults Resources and Services (OARS) Multidimensional Functional Assessment Questionnaire adapted for the caregiver.
|
Through study completion, an average of 4 months.
|
Change in falls and near falls from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Falls nand near falls recorded by patient diary
|
Through study completion, an average of 4 months.
|
Change in falls and near falls from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Falls and near falls recorded from the Apple Watch® proprietary algorithm.
|
Through study completion, an average of 4 months.
|
Adverse drug events and adverse drug withdrawal events
Time Frame: Continuous during the deprescribing process
|
Adverse anticholinergic and sedative effects from G-MEDSS
|
Continuous during the deprescribing process
|
Change in Montreal Cognitive Assessment (MoCA) from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Full version
|
Through study completion, an average of 4 months.
|
Change in Trail Making Test (TMT) from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
Part A & B
|
Through study completion, an average of 4 months.
|
Change in Digit Symbol Substitution Test from baseline to study completion
Time Frame: Through study completion, an average of 4 months.
|
DSST
|
Through study completion, an average of 4 months.
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Estimated)
Study Completion (Estimated)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- PJT-183968
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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