A new study by The University of Western Australia’s (UWA) Centre for Health and Ageing has found the majority of aged care residents are at risk of suboptimal medicine prescription which can lead to serious complications.
Titled Polypharmacy and medicine regimens in older adults in residential aged care, the report collected data from 17 Australian aged care facilities and it discovered that 302 of 303 assessed residents were impacted by under-prescribing, over-prescribing or high-risk prescribing.
Polypharmacy, the use of multiple medications, was reported in 92% of aged care residents with an average of 14 to 15 medicines prescribed to each individual per day.
High-risk prescribing was almost as common with 81% of residents living with highly complex medical regimens that need to be followed precisely.
Dr Amy Page, a Senior Research Fellow at UWA and one of the report’s co-authors, said the prevalence of prescribing multiple medicines has increased notably in the past decade.
“Older people with multiple chronic conditions have [the] potential to benefit from quality use of medicines but are at high risk of experiencing medicine-related harm if prescribing is suboptimal,” Dr Page said.
“The over-prescribing and under-prescribing actually happen a lot in the same people, which is what makes it particularly problematic.
“A number of people are receiving prescribing cascades, which is where one medicine might be used to manage the side effects of another medicine. Instead of identifying symptoms as a side effect, they’re identifying it as a new condition.
“There are people receiving a lot of medicine, but at the same time, are not receiving something they might be benefiting from. As a result, they’re actually missing out on potential benefits.”
Dr Page said the residents are not the only ones at an increased risk of negative outcomes, as staff face additional pressure due to the management and delivery of high-risk regimens.
There is also a negative opportunity cost as meaningful care minutes are replaced by medicine administration.
“Our research also reveals the significant burden that the complexity of medicines is placing on not only residents at aged care facilities but also the staff.
“It takes about five minutes per resident to administer complex regimens. If you have staff members dedicated to administering medicine, and it’s a highly complex regimen, that means they’re taking longer to do so.
“That’s taking away from the time when they could be doing more meaningful activities with the residents that they would potentially get more value out of, like non-pharmacological interventions or social activities.
“There’s the opportunity cost that’s involved and we can’t underestimate the opportunity cost. There’s only so much that can be done at any one time.”
She also highlighted the additional time taken to mix and administer crushed medicines in liquids to approximately 20% of aged care residents due to swallowing difficulties.
The report has been published at a time when medicine safety and the quality use of medicine are receiving additional attention from the Australian Commission on Safety and Quality in Health Care (the Commission).
The Commission is currently developing a roadmap to embed the defined Quality Use of Medicine Principles into aged care to ensure medicines are used to best improve health outcomes.
The first part of this was achieved through the 2021 National Baseline Report on Quality Use of Medicines and Medicines Safety – Phase 1 Residential Aged Care report.
Dr Page said better structures are needed to properly support the multidisciplinary care of aged care residents who are taking a number of medicines.
She said regular medication reviews would provide an appropriate understanding of an individual’s changing health needs so they are taking the medicine they need, and not something causing harm.
