Dr. Carole Goodine
It’s been hundreds of years since the Greek storyteller Aesop said it is possible to have “too much of a good thing.” This tenet resonates deeply with Dr. Carole Goodine, a New Brunswick pharmacist who maintains that while medication can be essential to the health of older adults, medication overload can be just as harmful.
Dr. Goodine recently co-published a study in JAMA Network Open showing that the use of a clinical decision app—MedReviewRx—alongside routine medication reviews in five New Brunswick long-term care homes, increased ‘deprescribing’ of medications by 23.7 per cent. The study involved 725 people.
As clinical pharmacy manager at Dr. Everett Chalmers Regional Hospital in Fredericton, Dr. Goodine conducted the study with an interprofessional team. The app was designed and piloted during a two-year fellowship co-funded by AGE-WELL and the New Brunswick Health Research Foundation (now ResearchNB).
“As you age, your body and the way you process some medications may change, so you might be at higher risk for side effects,” she explains. “The purpose of the app is to identify medications that might cause more harm than benefit—those considered risky for older adults—and provide physicians with a guideline as to how to safely reduce or stop them.”
Between 68 and 88 per cent of people living in long-term care homes are affected by potentially inappropriate prescribing of medication, which can contribute to adverse drug events such as falls, fractures, cognitive decline, hospitalization and death. The number of prescriptions increases with age: 62 per cent of Canadians aged 65 and older take five or more medications.
“One of the key things that came out of AGE-WELL was the concept of making sure research projects are co-designed with the users.”– Dr. Carole Goodine
Taking five-plus medications, medications that are no longer needed, or that are not the best fit for a person is known as ‘polypharmacy.’ Deprescribing is a key priority for improving health outcomes among older Canadians, says Dr. Goodine, who was named the Canadian Pharmacists Association’s 2023 Canadian Pharmacist of the Year for her efforts to improve care for older adults.
During her AGE-WELL fellowship, Dr. Goodine also participated in AGE-WELL’s EPIC (Early Professionals, Inspired Careers) program and the 2017 EPIC Summer Institute, held in Shediac, New Brunswick.
A pharmacist with 34 years of experience but new to research, she says EPIC gave her a solid understanding of research: “EPIC was an incredible opportunity to get some building blocks and exposure to the research process. It also offered opportunities in other areas such as commercialization and project management, and connected you with professionals from different backgrounds. It really gave you a good overview of the landscape.”
At the Summer Institute, Dr. Goodine was particularly struck by the involvement of older adults and caregivers in the research process. “One of the key things that came out of AGE-WELL was the concept of making sure research projects are co-designed with the users. Having that older adult sitting at the table from start to finish—making sure the project was going to meet their needs. Getting that perspective is so important.”
Collaborating with professionally diverse teams was also a highlight of the AGE-WELL experience: “There’s always something new to learn—something we can gain from working with people in other fields and learning new skills. I think that’s what helps you grow.”