When clinicians review a patient’s file, MedSafer flags potentially inappropriate medications. In a new clinical trial, the software helped deprescribe such medications in 36 per cent of long-term care residents, nearly triple as many as when reviews were done without the tool.

“Sometimes we blame aging for memory loss or mobility issues when the real culprit is the medications,” said lead author Dr. Emily McDonald, Associate Professor in McGill’s Department of Medicine, Scientist at the Research Institute of the McGill University Health Centre (The Institute) and attending physician at the McGill University Health Centre. “I’ve seen patients go from barely responsive to having conversations again after stopping a sedating medication.”

Nearly two thirds of Canadian seniors take five or more medications a day, and the number is significantly higher in long-term care, she added.

How the tool fits into routine care

Medications are typically reviewed every three months in long-term care homes, but the scholars say there’s no standard approach to deprescribing.

MedSafer works as a checklist for clinicians. It scans a resident’s medication list alongside their health conditions, flags drugs that may no longer be appropriate and provides guidance on how to stop some medications or for safer alternatives.

The software was co-developed by McDonald and Dr. Todd Lee, Associate Professor in McGill’s Department of Medicine and Scientist at The Institute . The trial involved 725 residents in five long-term care homes in New Brunswick who were taking an average of 10 medications each.

The problem with ‘prescribing cascades’

Medications often accumulate over time and are sometimes prescribed to counteract the side effects of other drugs, a pattern known as a “prescribing cascade.”

“Some medications can increase the risk of falls, confusion and hospitalizations,” said Lee. “The more you take, the more side effects and interactions you can have.”

The researchers’ goal is to see MedSafer integrated into primary care, so that overmedication can be addressed before patients enter long-term care.

“This should be the new standard of care for older adults,” McDonald said. “No one should be on a medication that’s doing more harm than good.”

About the study

“Electronic Decision Support for Deprescribing in Older Adults Living in Long-Term Care” by Emily McDonald and Todd Lee et al. was published in JAMA Network Open.

The research was funded by the Healthy Seniors Pilot Project, a joint initiative of the Public Health Agency of Canada and the Government of New Brunswick.

McDonald and Lee are co-founders of MedSafer Corp., which licenses the software used in the study.

Caparrós, holder of a PhD in Physical Activity and Sports Sciences, seeks to examine new methods and procedures for improving the efficacy of physical activity programmes to treat different conditions in a study that has received funding from Spain’s Ministry of Science and Innovation. The first research results, published in open access, involve a non-quantitative analysis of 13 studies from between 2011 and 2021 designed to examine the extent to which people’s individual characteristics and conditions are taken into account when prescribing and carrying out physical activity programmes.

The importance of physical activity in health

Everyone aged between 18 and 64 should carry out between 150 and 300 minutes of moderate (or between 75 and 150 minutes of intense) physical exercise per week. Those aged 65 and over should also complement this activity with exercises designed to enhance their quality of life and reduce risks of harm. These are the recommendations made by the World Health Organization (WHO), which also says that physical activity can help in the prevention and management of non-communicable diseases, such as cardiovascular conditions, cancer and diabetes.

The WHO defines physical activity as ‘any bodily movement produced by skeletal muscles that requires energy expenditure’ The term therefore refers to ‘all movement including during leisure time, for transport to get to and from places, or as part of a person’s work’. In other words, the WHO includes in this definition everything from walking and playing to intense sporting activities. So, this differentiates general physical activity from physical exercise, defined by the American College of Sports Medicine as planned, structured, and repetitive bodily movement done to improve or maintain one or more components of physical fitness.

For both physical activity and physical exercise, digital and mobile health (mHealth) tools are becoming increasingly common and are being heralded as a solution for improved management, evaluation and monitoring by medical professionals. ‘Face-to-face sessions are effective and necessary, but the digital sphere also has its advantages. It helps encompass broader swaths of the population and reach those who, because they are geographically more remote or have difficulties in travelling, cannot access face-to-face treatments,’ said Caparrós. ‘If we can ensure that there is fluid communication using digital tools, these programmes can end up being highly effective.’

Towards higher quality, more individualized exercise

After drawing up an initial longlist of more than 400 works of research on the use of mobile technology in physical activity programmes, UOC researchers ended up whittling the number down to 13 academic publications meeting the criteria they were seeking to assess. These are the principal conclusions of their analysis:

• • Improved intervention efficacy. 70% of cases studies showed a significant improvement in the efficacy of physical activity treatments.
• • Improved adherence. 85% of the studies analysed concluded that treatment adherence (sticking with it) was greater when mHealth technologies were involved.
• • A quantity-centred approach. When it came to studying the impact of these treatments, most research focused on the amount of exercise (e.g. the number of steps in a day) rather than the intensity or quality.
• • Mobiles and apps, most frequently used. Although some treatments were provided through technologies like text messages or social networks, the most common support came in the form of mobile apps and smartphones.
• • Scant individualization of treatments. Almost none of the studies analysed reflected the adaptation of physical activity programmes to take account of the patient’s abilities, age or illness.

‘Even though the sample analysed is very small, the first noteworthy conclusion is that digtial-based physical exercise interventions are at least as effective as face-to-face ones,’ explained Caparrós. ‘But we’ve also seen how all these proposals use very generic variables and fail to provide quality information, as their designs are not tailored to the participants or their illnesses. Obviously, you can’t interact with someone over 70 in the same way as you would with a young person with a completely different digital skillset.’

This has led his research towards a new line of study, which will continue over the course of the work on the thesis, to improve the digital-health-based prescription of physical exercise to take account of patients’ individual requirements (based on their illness and physical condition and prescribed in accordance with medical criteria) and their digital skillset. ‘Quantity-wise, it’s easy to manage exercise online, but when it comes to quality and intensity, which are what really matter, no sufficiently in-depth analysis has been conducted,’ said Caparrós.

This research is funded by the Spanish Ministry of Science and Innovation.

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