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Call for clinicians and aged care providers to ‘deprescribe’ residents’ unnecessary medications

Alleviating pain and maintaining quality of life are central to care for people with dementia. However, there is a growing body of evidence suggesting that older Australians, including those with dementia, are being prescribed unnecessary or inappropriate medications, increasing their chance of hospitalisations that would not otherwise occur.

Recent research, funded by the Alzheimer’s Australia Dementia Research Foundation and Resthaven Inc., has found that aged care residents with multiple medications or complex drug regimens are more likely to be hospitalised than those without.

The research team from Monash University’s Centre for Medicine Use and Safety, have called for clinicians and the aged care sector to implement strategies to ensure that residents’ medication regimens are consistent with their goal of care. This includes ensuring that residents’ medication regimens are regularly reviewed and that any unnecessary or inappropriate medications are targeted for ‘deprescribing’.

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.

“Sometimes a medicine is appropriate when prescribed by itself, but it may cause interactions when combined with other medicines. Specific classes of medicines that are highly prevalent among residents with polypharmacy, such as cardiovascular and psychotropic medicines, may contribute to fall-related hospitalisations,” said lead researcher Associate Professor Simon Bell.

“Whilst polypharmacy is sometimes necessary for managing residents’ medical conditions, earlier research suggests that approximately half people with dementia living in aged care facilities take one or more medicines that may be potentially unnecessary or no longer appropriate.

“This often occurs because the risk-to-benefit ratio for prescribing long-term preventative medicines changes over time. Medicines that were once prescribed appropriately may be unnecessary or even inappropriate in the residential aged care setting."

The research concluded that residents with polypharmacy had an 89 per cent higher risk of hospitalisation and had a higher number of hospital days than their counterparts with less complex medication regimens.

Associate Professor Bell said that adverse drug events are a leading cause of hospitalisations among older Australians. Residents of aged care facilities may be particularly susceptible due to factors such as frailty, reduced renal function and impaired cognition.

“Our systematic review of 44 Australian and international studies found that up to 74 per cent of residents use nine or more medicines on a regular basis," he said.

A second study by the Centre for Medicine Use and Safety concluded that 79 per cent of residents of aged care facilities would be willing to trial having some of their medications deprescribed if their doctors say that it is possible.

“It’s important for clinicians to regularly review each resident’s overall medicine regimen to ensure that it is consistent with the resident’s goals of care. If you or the person you care for has been taking multiple medicines for a long period of time then it’s a good idea to ask your doctor or pharmacist for a review.

“This can help make sure the medicines you or your family member take are still the most appropriate. However, it’s important to discuss with your doctor or pharmacist first before stopping your medicines” said Associate Professor Bell.

Sources: 

Simon Bell received an Alzheimer’s Australia Dementia Research Foundation (AADRF) Resthaven Inc Research Grant in 2012. For more information on grants or to apply click here.

Pictured: Lead researcher Associate Professor Simon Bell
 

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