NEW research showing a high prevalence of polypharmacy in older Australians has highlighted the need to help patients better manage their ever more complex medical regimens.
The study, published in the MJA, was based on a postal survey sent to a random sample of 4500 Australians aged 50 years and older. Just over a third responded. It found that 43% of participants had taken five or more medicines (conventional and/or complementary) in the previous 24 hours and 87% had taken at least one medicine over the same time frame. (1)
The authors found that polypharmacy (defined as five or more medications taken in 24 hours) was significantly associated with increasing age — 66% of participants aged 75 years and older were taking five or more medications.
The research found that polypharmacy had increased since the National Health Survey in 1995, as had the proportion of people taking lipid-lowering agents and antidepressants. (2)
The authors stressed the need to support safe and effective use of medicines and called for “further research into appropriateness of medicines use”.
“Although medicines can play a pivotal role in the quality of life of older people, polypharmacy can contribute to non-adherence and increase the risk of adverse drug reactions”, the authors wrote.
Another recent study of polypharmacy in older Canadians backed this view. Researchers found that 12% of people aged 65 years and older who were taking five or more medications experienced a side effect that required medical attention compared with just 5% of seniors taking only one or two medications. (3)
“Even when controlling for age and number of chronic conditions, the number of prescription medications was associated with the rate of emergency department use”, the Canadian authors wrote.
Professor Leon Flicker, professor of geriatric medicine at the University of WA, said the issue grew more pressing as people aged because older people were less able to clear drugs from their systems and were more sensitive to drug side effects.
He said managing patients on multiple medications was complicated, especially those with more than one condition, because the guidelines for different medicines were usually built around single diseases.
“GPs are obviously the linchpin as they are in a position to coordinate care across multiple specialists — but it is demanding work, especially when you’re talking about multiple medications, and it does require time.”
The Australian researchers also found that complementary medicines, particularly fish oil and glucosamine, were used by 46% of participants.
Rohan Elliot, a senior aged care pharmacist at Austin Health and a senior lecturer in pharmacy at Monash University, said regular medication reviews should ideally incorporate a home visit to obtain an accurate medication list, including over-the-counter and complementary medicines.
Dr Janette Randall, chair of the board at NPS, said GPs could make more use of home medicine reviews. She said the rules for reviews had recently changed and GPs could now refer patients directly to an accredited pharmacist of their choice.
“GPs have not used home medicine reviews much because they never knew who would be doing the review and the quality of those reviews was variable — but that barrier has gone”, Dr Randall said.
One of the study’s authors, Dr Marie Pirotta, a senior lecturer in the department of general practice at the University of Melbourne, said the home medicines review scheme was a “great initiative”.
She said part of the reason why patients were on so many medications was that it was easier to start someone on a medication than it was to stop one. “As GPs, we need to be much better at reviewing medicines and their role in a person’s treatment plan over time.”
– Amanda Bryan
Posted 16 January 2012