As America’s population ages, the risks associated with polypharmacy – taking multiple medications simultaneously – are becoming increasingly urgent. In the United States, nearly 1 in 4 adults aged 65 years and older falls each year, making falls the leading cause of injury-related death in this age group. These falls account for more than 36,000 deaths and more than 3 million emergency department visits annually. Many of these falls are preventable and closely linked to medication-related complications.
The problem is especially acute in South Florida, which has one of the highest concentrations of older adults in the country. A significant percentage of these individuals are on five or more medications daily, increasing their risk of harmful drug interactions, confusion, dizziness and eventually, falls. Certain medications, such as sedatives, antidepressants, antipsychotics, antihypertensives and opioids, are particularly associated with a 60% to 70% increased risk of falling. Furthermore, older adults on four or more medications are one-and-a-half times more likely to experience a fall, and each additional medication increases the risk by up to 21%.
To address this pressing issue, the GREAT PHARM project will implement a randomized controlled study involving older adults who visit emergency departments following a fall. Participants in the intervention group will receive pharmacogenomic testing to guide safer prescribing, with results shared directly with their primary care providers for medication optimization. Pharmacogenomics is a type of personalized medicine that uses your DNA to help doctors choose the safest and most effective medications for you. The control group will receive usual care. Patients will be followed for 12 months, during which researchers will monitor ADEs, repeat ED visits, fall recurrence and patient-reported wellbeing.
“Our goal with GREAT PHARM is to take the guesswork out of prescribing for older adults by using pharmacogenomics to tailor medications to each individual’s genetic profile. We believe this approach will significantly reduce adverse drug events – especially serious outcomes like falls – and improve how patients feel day to day,” said Richard Shih, Ph.D., principal investigator and professor of emergency medicine in FAU’s Schmidt College of Medicine. “This isn’t just about reducing harm; it’s about enhancing quality of life and empowering physicians with precise, evidence-based tools to make safer, more effective prescribing decisions.”
The project also will include quantitative and qualitative analyses. In addition to measuring clinical outcomes, researchers will assess the prevalence of harmful drug-gene combinations and abnormal drug levels in patients with specific genetic profiles. Additionally, they will explore patient experiences and identify potential barriers and enablers to incorporating pharmacogenomic testing into routine care.
“With South Florida’s large and rapidly aging population, addressing the risks of polypharmacy and falls among older adults is not just important – it’s a public health imperative,” said Lewis S. Nelson, M.D., dean and chief of health affairs of the FAU Schmidt College of Medicine. “The $1 million grant awarded to support the GREAT PHARM project represents a major step forward in protecting older adults from preventable harm. Through this initiative, our research team aims to implement safer, evidence-based prescribing practices in emergency settings, reduce medication-related complications, and ultimately, lower the incidence of falls and hospitalizations. Florida Atlantic is proud to lead this multidisciplinary effort and set a new standard for geriatric care both locally and nationally.”
The interdisciplinary research team includes leading experts in emergency medicine, geriatrics, pharmacology, clinical research and biostatistics, ensuring that the project is not only scientifically rigorous but also deeply informed by real-world clinical practice.
Co-investigators of GREAT PHARM include Joseph G. Ouslander, M.D., a professor of geriatric medicine; Mike Wells, Ph.D., research assistant professor, Department of Emergency Medicine; Scott M. Alter, M.D., assistant dean for clinical research and associate professor of emergency medicine; Lisa Clayton, D.O., associate dean for graduate medical education and designated institutional official, chair and associate professor of the Department of Emergency Medicine, and director, emergency medicine residency; and Joshua J. Solano, M.D., associate professor of emergency medicine, all with FAU’s Schmidt College of Medicine; Anita Chary, M.D., Ph.D., an assistant professor, Baylor College of Medicine; Gregg Fields, Ph.D., FAU vice president for research; and David Newman, Ph.D., a professor and statistician, FAU Christine E. College of Nursing. Gabriella Engstrom, Ph.D., a research assistant professor of emergency medicine, FAU Schmidt College of Medicine, will serve as project coordinator.
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About the Charles E. Schmidt College of Medicine:
Florida Atlantic University’s Charles E. Schmidt College of Medicine is one of approximately 159 accredited medical schools in the U.S. The college was launched in 2010, when the Florida Board of Governors made a landmark decision authorizing FAU to award the M.D. degree. After receiving approval from the Florida legislature and the governor, it became the 134th allopathic medical school in North America. With more than 170 full and part-time faculty and more than 1,300 affiliate faculty, the college matriculates 80 medical students each year and has been nationally recognized for its innovative curriculum. The college offers M.S. (thesis and non-thesis) and Ph.D. programs in biomedical science, along with a certificate in genomics and precision medicine. Taught by top researchers, the curriculum combines cutting-edge coursework with hands-on learning, preparing graduates for careers in medicine, research, industry, and academia. To further Florida Atlantic’s commitment to increase much needed medical residency positions in Palm Beach County and to ensure that the region will continue to have an adequate and well-trained physician workforce, the FAU Charles E. Schmidt College of Medicine Consortium for Graduate Medical Education (GME) was formed in fall 2011 with five leading hospitals in Palm Beach County. The consortium currently has five Accreditation Council for Graduate Medical Education (ACGME) accredited residencies including internal medicine, surgery, emergency medicine, psychiatry, and neurology, and five fellowships in cardiology, hospice and palliative care, geriatrics, vascular surgery, and pulmonary disease and critical care medicine. The college also manages the Florida Atlantic University Medical Group, offering comprehensive primary care, and the Marcus Institute of Integrative Health specializes in integrative pain management, precision therapies, and mental health. A 2023 partnership with Broward Health expands academic medicine, clinical training, and research opportunities.
About Florida Atlantic University:
Florida Atlantic University, established in 1961, officially opened its doors in 1964 as the fifth public university in Florida. Today, Florida Atlantic serves more than 30,000 undergraduate and graduate students across six campuses located along the Southeast Florida coast. In recent years, the University has doubled its research expenditures and outpaced its peers in student achievement rates. Through the coexistence of access and excellence, Florida Atlantic embodies an innovative model where traditional achievement gaps vanish. Florida Atlantic is designated as a Hispanic-serving institution, ranked as a top public university by U.S. News & World Report, and holds the designation of “R1: Very High Research Spending and Doctorate Production” by the Carnegie Classification of Institutions of Higher Education. Florida Atlantic shares this status with less than 5% of the nearly 4,000 universities in the United States. For more information, visit www.fau.edu.
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