# Implementation of a Medication Care Plan to Reduce Unintentional Injury among Rural Older Adults

> **NIH ALLCDC U01** · UNIVERSITY OF IOWA · 2021 · $749,193

## Abstract

PROJECT ABSTRACT
Falls are the leading cause of unintentional fatal and nonfatal injury among older adults in the United States. In
Iowa, rates of fall-related deaths and hospitalizations among older adults are higher than the national average.
More than one-third of older adults fall each year in the U.S., and many of these falls result in injury, decreased
or permanent loss of functioning, loss of independence and a fear of falling. We know that certain medications,
including those that affect the central nervous system (CNS), increase the risk of a fall among older adults and
that interventions targeting withdrawal of these medications reduce falls and fall-related injuries. We also know
that reaching high-risk older adults, including those living in rural communities, with falls prevention programs
can be challenging. On their own, older adults do not typically engage in falls prevention behaviors and often
report that limited support from healthcare providers is a barrier to participation in falls prevention programs.
The long-term goal of the proposed study is to develop a sustainable program for healthcare systems to
reduce fatal and nonfatal falls among high-risk older adults living independently in their communities. The
objective of the proposed study is to examine how a medication care plan, grounded in established
medication de-prescribing and tapering frameworks, can be implemented in primary care clinics to reduce
medically-treated falls among older adults living in rural Iowa communities. The proposed study is a
collaboration between researchers and clinical pharmacists at the University of Iowa and a clinical team from
the Mercy Health Network Accountable Care Organization (ACO), which is a non-academic healthcare system
with significant reach into rural Iowa communities. Leveraging an existing partnership with the Mercy ACO, we
will use an effectiveness-implementation hybrid design to accomplish the following specific aims: (1) Examine
the effectiveness of a clinic-based, individualized medication care plan in reducing rates of medically treated
falls (sub-aim 1a) and motor vehicle charges and crashes (sub-aim 1b) among older adults seen in rural
primary care clinics, (2) Identify provider and patient factors that are associated with patient adherence to
medication deprescribing and discontinuation recommendations, and (3) Evaluate implementation of the
medication care plan to understand its acceptability, usability and relevance among healthcare system
administrators, clinics (clinic managers and clinical staff), providers (health coaches, pharmacists, prescribers)
and patients. Accomplishing these aims will result in a framework for how individualized medication care plans,
developed to reduce medically treated falls among older adults, can be effectively disseminated through a
healthcare system and implemented by older adults.

## Key facts

- **NIH application ID:** 10241889
- **Project number:** 5U01CE002961-04
- **Recipient organization:** UNIVERSITY OF IOWA
- **Principal Investigator:** CARRI CASTEEL
- **Activity code:** U01 (R01, R21, SBIR, etc.)
- **Funding institute:** ALLCDC
- **Fiscal year:** 2021
- **Award amount:** $749,193
- **Award type:** 5
- **Project period:** 2018-09-30 → 2022-09-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10241889

## Citation

> US National Institutes of Health, RePORTER application 10241889, Implementation of a Medication Care Plan to Reduce Unintentional Injury among Rural Older Adults (5U01CE002961-04). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/10241889. Licensed CC0.

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