Aged care providers need to look into alternatives to medications to address the overuse of some medicines among residents, a lead researcher tells Australian Ageing Agenda.
Research published in the latest International Journal for Quality in Health Care aimed to identify medication-related quality of care for Australian aged care residents using an administrative healthcare claims database.
It found that at 1 January 2013 over 73 per cent of almost 17,700 aged care residents were exposed to overuse of medications associated with high-risk falls. Forty-one per cent were exposed to overuse of benzodiazepines, commonly used as sleeping tablets, which are associated with falls, problems with memory and long-term addiction.
The research also found there was an overuse of antipsychotics (30 per cent) and medications with moderate to strong anticholinergic, or neurotransmitter-blocking, properties (46 per cent).
Lead researcher Jodie Hillen, a senior research analyst at Ward Medication Management said instead of rushing to medicate, providers should consider setting up an environment that is less likely to cause behavioural issues in the first place.
Having GPs and nurse practitioners on site could also result in better monitoring of medication overuse, she said.
Ms Hillen said when some medications are overused, their effects are diminished.
“We’re exposing them to medicines that they’re not getting the effect from, but they’re getting the risks from. I think that’s a little disheartening,” Ms Hillen told AAA.
Monitoring medication use is also important in reducing unnecessary hospitalisations, where 30 per cent of all hospital admissions of those over the age of 65 are related to medications, she said.
“It’s been estimated that $1.2 billion dollars of annual costs are related to medication-based hospital admissions. It is not only harm to individuals, but also causes economic harm and burdens the health care system,” Ms Hillen said.
Poor uptake of collaborative health services such as underutilisation of medication reviews (42 per cent) were also found.
She said while there is a system in place that allows residents to undergo a medication review by receiving a referral from a general practitioner, it is limited to once every two years and there is no follow up.
“We need a more ongoing continuous collaborative model where health professionals can work together on several occasions to ensure the medication is tailored to that individual’s needs and their health goals,” Ms Hillen said.
Providers can lower medication use by looking to use alternatives other than medication, and only to choose medications when they are necessary, she said.
“The environment isn’t always addressing resident needs, so people choose medications instead of looking at the environment.
“Setting up an environment that is more settling for someone with dementia, they are less likely to have behavioural issues and therefore less likely to need medications,” Ms Hillen said.
Having onsite GPs and clinical nurse practitioners and residents having an ongoing relationship with health care professionals that follow up their medication use are among other ways providers can implement innovative approaches to address medication overuse in their facilities.
“It’s a non-invasive procedure, where their ability to metabolise or respond to a medication can be analysed. This will really inform doctors which medications are best for each resident, because sometimes they won’t really respond to a medication or sometimes they can overrespond,” Ms Hillen said.
Access the paper, Medication-related quality of care in residential aged care: an Australian experience here.
Find out more on Ward Medication Management here.
Comment below to have your say on this story
Send us your news and tip-offs to editorial@australianageingagenda.com.au
Subscribe to Australian Ageing Agenda magazine and sign up to the AAA newsletter
Thanks to these researchers for highlighting yet again the high and inappropriate use of medications in the aged care sector.
The rates of use of psychotropic medication appear disproportionally high. They are not rates per aged care home but rates of use in a very select sample of residents. The study also used old data from 2013 – 5 years ago. In national prevalence research, we have found rates of antipsychotic use dropped during 2014-2015 in response to TGA & PBS restrictions and media publicity.
I think it’s important to stress that all participants in this study were DVA gold card holders. These are not typical residents (e.g. av. age 90 as opposed to 85 years) and represent less than 8% of all aged care residents in total. Gold Cards are issued to people who are ex-prisoners of war; are returned ex-servicewomen/men or those ex-serviceman who have high rates of disability. Widowers also qualify under certain circumstances.
Extensive qualitative research has shown that most psychotropic prescribing – as you highlight – is driven by underlying beliefs of nurses and other health practitioners that these medications are more effective than they are and that side effects are overblown. The organisation and culture of each home is hugely influential. We need to challenge these beliefs through education and offer training in non-drug interventions as Ward Medication Management have been active participants in. Only then true lasting change will be seen.
Once again it is others making decisions for the frail aged members of the community. In one breath we want them to control their services and decide which to have and which to go with out (CDC), but then we decide which medications they should have and which they should have to manage without. If I ever end up in Age Care (God Forbid) and I have chronic pain which a large percentage of older people have I want adequate pain relief, not to be told to “think about something else” or as one person I met was told “you will just have to learn to live with it”. If I become addicted so be it, if I spend my days sleeping, so be it but don’t tell me how to deal with my pain and what I can have to treat it.