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The significance of the PHARE Study Group research program is underscored by the “silver tsunami” occurring with the aging of the population and the growth of the long term care industry. Older adults consume 31% of all medications prescribed, the average number being between two to six prescribed medications. Despite this, older adults are under-represented in clinical trials and post-marketing surveillance studies which has given rise to the “geriatric pharmacoparadox”.

Is it appropriate to generalize knowledge from randomized trials to residents in long term care settings? We think not. Given the aging-related changes in pharmacokinetics/dynamics, older adults are at increased risk of adverse drug events. Nursing homes are home to a clinically complex patient population who little resemble the typical randomized clinical trial study participant. As such, instead of evidence-based medicine, we are left with evidence-“biased”. Extrapolating information from trials to the typical nursing home resident with complex drug regimens and multiple comorbidities may not be what is best. We believe that we can leverage existing “big data” collected by federal mandate on virtually all nursing home residents in the US and apply advanced statistical techniques to provide the foundational knowledge on which to ultimately provide “personalized” disease management to a population deserving of improved quality of life, relief from suffering, and dignity in care. Our approach seeks to complement evidence from randomized clinical trials to include “medicine-based evidence” from the experiences of residents included in the large, national repositories of nursing homes