Almost one million Australians aged 70 and over take five or more medications daily, placing them at increased risk of unwanted side effects, more frequent hospital admissions, and falls.
The most recent figures, taken from a joint University of Western Australia and University of New South Wales study, found that the number of older people taking five or more medicines increased by 52 per cent between 2006 and 2017, despite evidence that this practice places patients at risk of harm and is associated with poor clinical outcomes.
Dr Mark Morgan from the Royal Australian College of General Practitioners (RACGP) said that while polypharmacy is sometimes seen as an ‘inevitable’ part of ageing, GPs should be able to engage in targeted de-prescribing.
“Many GPs have observed how patients gather medicines as they gather specialists,” he said.
“It is hard for our specialist colleagues to reduce or stop medicines that were recommended by a different speciality. How confident will a cardiologist be at changing gynaecologist medications?
“The GP role in reducing inappropriate polypharmacy is central. GPs are uniquely placed to be able to determine patient values, to understand social circumstances and to be able to identify medicines for de-prescribing.”
Dr Morgan said that while many GPs will reduce and cease medications as part of palliative care, de-prescribing should be considered in any patient with polypharmacy. As an example, he pointed to a pilot study he helped conduct that assessed systems of care used to achieve de-prescription and increase patient safety.
“We identified over 75-year-olds at high risk of hospital admission, then used the senior health assessment to establish patient priorities for care. Patients entered a multimorbidity care plan and quarterly review cycle that allowed the GP time to taper medications,” he explained.
“Simple steps to improve safety included reconciling the medication list, checking patient renal function and standing blood pressure.
“The project identified many patients who were at risk from over-treatment of diabetes and blood pressure. Other patients were taking medicines that were part of a prescribing cascade where side effects from one treatment led to prescriptions for the next and so on.”
The latest research, based on a 10 per cent random sample of people eligible for medicines listed on the Pharmaceutical Benefits Scheme between 1 January 2006 and 31 December 2017, found people in their 80s are most likely to take five medicines or more a day.
Lead researcher Dr Amy Page believes that while the increase could be attributed to a growing ageing population, more needs to be done to ensure medication management balances the potential for benefits against the potential for harm.
“The medicines we looked at do not include medicines purchased without a prescription, such as vitamins, minerals, herbal supplements or medicines not listed on the Pharmaceutical Benefits Scheme, meaning that the estimates in the paper may be conservative,” Dr Page said.
“The rates in comparable years are also much higher in Australia than in the US or the UK.”
Dr Page also said that strategies targeting both health professionals and the public, and which seek to increase people’s understanding of the potential risks involved in taking multiple medications, are needed.
“Taking multiple medications may be necessary, but it needs to be carefully assessed by a medical professional and balanced against the potential risks.”
How many medications do you take on a daily basis?
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