About
DWARAA is a nonprofit division of Sevadar Foundation Inc., a 501(c)(3) public charity, addressing medication burden in older adults. It is a registered trade name of that foundation and the fourth such division, alongside CareGuard, Valor Medica and IntellaRx.
Why the program exists
Two things are true at once about medication in older adults, and most discussion of the subject picks one and ignores the other.
The first is that older adults are, as a group, taking more medication than the evidence supports. Lists accumulate. A drug started in a hospital for a transient problem becomes a standing prescription. A side effect gets treated as a new condition. Nobody who contributed to the list ever saw all of it at once.
The second is that undertreatment is also real, and that the correction for overprescribing is routinely applied as a blunt instrument — a target number, a policy, a percentage reduction — to people whose individual circumstances never entered the calculation. Someone whose pain is controlled and whose function is good does not benefit from having that reversed to meet a metric. Deprescribing that is done to a person rather than with them is not stewardship; it is a different kind of failure with better paperwork.
DWARAA exists in the space between those two facts. It is a sequence for asking the question well, one person at a time.
What DWARAA does
- Publishes the framework — six steps, in order, with the reasoning for the order. The framework.
- Publishes the evidence base, including the parts that do not support the field’s more confident claims. The evidence.
- Writes for four audiences separately, because a prescriber, an owner, a family member and a nursing assistant need different things from the same list.
- Maintains a drug-class library for the classes that most often need review. The library.
What DWARAA does not do
What DWARAA is, and is not
DWARAA does not prescribe, deprescribe, diagnose or treat. Those are decisions made by a patient and their own clinicians, with the whole record in front of them. What DWARAA supplies is the framework, the evidence behind it, and the shared vocabulary that lets a family, a nurse, a facility and a prescriber talk about the same medication list and mean the same thing.
DWARAA also publishes no prices, sells nothing, and makes no claims about money saved by anyone who adopts the framework. Those claims are common in this field and they are not ours to make.
The people and the parent organization
Clinical content is written and reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, the program’s founder and medical director. The operating entity is Sevadar Foundation Inc.
Related divisions: CareGuard, the AHRQ-listed Patient Safety Organization, which publishes the facility safety review that several of these pages refer to; and Sevadar Foundation, the parent charity.