Call for aged care to ‘deprescribe’ residents’ unnecessary medications
A Monash University and Resthaven research collaboration has found that aged care residents with multiple medications or complex drug regimens are more likely to be hospitalised than those without.
A Monash University and Resthaven research collaboration has found that aged care residents with multiple medications or complex drug regimens are more likely to be hospitalised than those without.
The researchers have called for the sector to include regular medication reviews for residents and strategies to discontinue unnecessary medicines.
The study, which took place over 12 months across six Resthaven facilities, investigated whether there was an association between polypharmacy – taking nine or more regular medications – and admission to hospital.
It was conducted by a multidisciplinary team including Associate Professor Simon Bell from Monash University’s Centre for Medicine Use and Safety.
The study found that residents with polypharmacy had an 89 per cent higher risk of hospitalisation and had a higher number of hospital days.
Associate Professor Bell said the study found that residents with complex medication regimens were more likely to be hospitalised than their counterparts with less complex regimens.
“The findings highlight the importance of regular medication review and, if necessary, strategies to discontinue or ‘deprescribe’ medicines that are unnecessary or no longer consistent with residents’ goals of care,” Associate Professor Bell told Australian Ageing Agenda.
“When performing medication reviews, it is important for pharmacists and GPs to assess whether there is an ongoing clinical need for all medicines that each resident takes. The findings also suggest the value of initiatives to simplify residents’ medicine regimens,” he said.
Tailored approach to medications needed
Associate Professor Bell said polypharmacy was not necessarily inappropriate as some medical conditions were best managed by taking multiple medicines.
However, he said many older people took medicines that were either unnecessary or no longer appropriate, often because the risk-to-benefit ratio for prescribing specific medicines changed as people aged.
“Older people in residential aged care may have different goals of care to people who live independently in the community. This means that medicine regimens need to be individually tailored to meet each resident’s goal of care,” he said.
Resthaven executive manager residential services Tina Cooper, who was also involved in the study, said the research had important implications for aged care and hospitals.
“Previous research indicates that adverse drug events are a leading cause of preventable hospital admissions among older Australians,” she said.
The research adds to the increasing body of evidence suggesting reducing the number of unnecessary or low-benefit medications may be a valuable way to reduce unwanted and expensive hospital stays, Ms Cooper said.
“We have always advocated for frequent medication reviews, but this takes it to the next level. We now need to look at risk-benefit ratios for prescribing of long-term preventative medications in aged care,” she said.
In response to the findings, Resthaven said it would consider its approach to deprescribing during 2017. It also intends to promote and discuss the potential for medication reviews with GPs and pharmacists and talk to residents and key stakeholders about the benefits of deprescribing.
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“Call for aged care to ‘deprescribe’ residents’ unnecessary medications” is a misleading title as it is not aged care responsible, it is GPs. It also would relate to all people ranging in age within the community or a residential setting.
There were medication reviews completed by pharmacists however as in all things this has been impacted by funding.
I have to agree with Denise that this article title should read Call for GP’s to “deprescribe” unnecessary medications.
We have considered prescribing rates across different sites and found that higher numbers of medications can be driven by family who want the latest treatment for all conditions. These same family members that request additional medications are the same family who drive hospital transfer in some cases. Just another angle to consider although I readily support appropriate deprescribing,
There are also family members who question the number of medications their loved ones are on, indeed sometimes the resident themself will, but in my experience neither the resident nor their representative is allowed much say in the matter sadly.
I agree, its a GP issue that needs evidence based healthcare applied.
We should also be encouraging older people to question the risk to benefit ratio of the medicines they have been taking for a long time. Medication reviews need to consider the whole lifestyle of a person with older person deciding where possible what is best for them.