Healthcare professionals should be proactive about discussing the reduction of unnecessary medication with aged care residents, with new research showing that almost 80 per cent of residents would be willing to have one or more of their medicines deprescribed if a doctor said it was possible.
Led by Monash University in collaboration with the University of Sydney, University of South Australia and provider Resthaven, the research was the first of its kind to measure aged care resident’s attitudes to medication use and deprescription.
Previous studies have shown many medicines taken by older people can be withdrawn safely and that discontinuation can be associated with maintaining quality of life.
Simon Bell, Associate Professor at Monash University’s Centre for Medicine Use and Safety, said it was important to understand residents’ attitudes towards medications so that prescribing was tailored to goals of care, noting that the benefit-to-risk ratio of medications often changed as people age.
“We know that many residents continue to take long-term preventative medicines. Although appropriate when first prescribed, in some cases these long-term preventative medicines may become unnecessary or even inappropriate,” he told Australian Ageing Agenda.
Of the 232 residents surveyed, 41 per cent reported an intrinsic desire to stop one or more of their medications, lower than has been found in previous studies with older people in hospital settings. However, if a doctor said it was possible, up to 79 per cent of residents were willing to have one or more of their medications deprescribed.
“A resident’s GP, pharmacist and other health professionals may have spent years or even decades highlighting the importance of good adherence. It may come as a surprise to residents, therefore, that it’s often possible to stop taking one or more of these medicines,” said Dr Bell.
That so many residents were willing to trial discontinuation if a doctor said it was possible highlighted the importance of health professionals initiating discussions about deprescription, said Dr Bell.
Looking at polypharmacy
Of the residents surveyed, 70 per cent took more than nine medications regularly – what was typically defined as polypharmacy.
While polypharmacy can be appropriate, it can also present challenges, such as increased risk of adverse events.
Surveyed residents who took more than nine medications were more likely to believe that their medications had side effects, however these residents were not significantly more likely to want to reduce their medications.
This result suggested clinicians shouldn’t necessarily use the number of medicines a resident was taking to identify residents who may be interested in deprescribing, said Dr Bell.
He encouraged residents and carers to discuss with their GP or pharmacist if it was possible to stop medications and how medication use fitted within their goals of care.
While aged care staff did not have direct input into prescribing, Resthaven executive manager of residential services Tina Emery said there was scope for providers to work with clinical pharmacists to open up the conversation around deprescription, and said Resthaven would look to promoting the study’s findings among GPs.
“This is all about people’s quality of life,” said Ms Emery.
“There’s lots of good roll on effects from [deprescription] in far as costs for older people, costs for government; costs to the PBS.”
The latest research was the second study conducted by Associate Professor Bell in collaboration with Resthaven.
As previously reported by AAA, the research team has also looked into pain management among those with dementia. Future studies planned to investigate possible associations between polypharmacy and quality of life, and between medication, falls and hospitalisation.
The study, Are residents of aged care facilities willing to have their medications deprescribed? was published in the journal of Research in Social and Administrative Pharmacy.
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