# Drug Reduction in Older Patients: The DROP Trial

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2020 · —

## Abstract

Anticipated Impact on Veterans Healthcare: Polypharmacy, defined in published studies as more than five
medications, and hyperpolypharmacy, defined as more than 10 medications, are both common in older
patients discharged to skilled nursing facilities (SNFs). Several recent studies demonstrate the prevalence and
potential inappropriateness of polypharmacy among older patients in both VA and non-VA healthcare settings.
Other studies have shown that polypharmacy can lead to multiple harmful outcomes among older community-
dwelling and hospitalized populations including decreased medication adherence, increased adverse drug
events and increased health care utilization and costs. Polypharmacy and a variety of drug indices that
quantify drug burden have additionally been found to be associated with the development of the following
geriatric syndromes: cognitive impairment, delirium, falls, urinary incontinence and unintentional weight loss.
Our innovative, patient-centered Drug Reduction in Older Patients (DROP) intervention has significant potential
to impact the health of a large population of older Veterans who are vulnerable to poor health outcomes. It is
during hospitalization and SNF care that older patients often acquire new geriatric syndromes and medications
and, thus, when deprescribing actions should be initiated by VA care providers. In addition, the clinical
oversight provided during the hospital and SNF stays allows the effects of medication changes to be more
closely monitored for safety relative to when the Veteran is at home.
Project Objectives: The proposed randomized, controlled trial will evaluate the effects of an intervention to
reduce exposure to medications (DROP) among hospitalized older Veterans discharged to skilled nursing
facilities (SNFs) using an effectiveness-implementation hybrid design to inform future dissemination efforts.
Project Background/Rationale: Patients discharged to SNF represent the largest segment of Medicare
beneficiaries discharged to post-acute care services and are a particularly high risk group for loss of
independence and other poor clinical outcomes. This investigative team recently completed a VA-funded
Quality Improvement Award and a Centers for Medicare and Medicaid Services (CMS) Innovation Award, both
of which provide strong preliminary data related to the prevalence of polypharmacy and the relationship
between polypharmacy and geriatric syndromes (e.g., medications associated with falls) in this patient
population. Based on these data, we developed and pilot-tested a patient-centered deprescribing intervention
combined with standardized screening assessments for eight geriatric syndromes to be implemented in the
hospital and monitored during the SNF stay.
Project Methods: We propose an innovative effectiveness-implementation hybrid design study that will be
conducted in one VA hospital. The goal of the proposed DROP intervention is to safely deprescribe
medications, as defined by dose reducti...

## Key facts

- **NIH application ID:** 9842291
- **Project number:** 5I01HX002441-02
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Amanda Salanitro Mixon
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-12-01 → 2022-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9842291

## Citation

> US National Institutes of Health, RePORTER application 9842291, Drug Reduction in Older Patients: The DROP Trial (5I01HX002441-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9842291. Licensed CC0.

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