Number of Medications a Predictor of Risk in Elderly
Anna McIntyre, HMR March 08
A recent article in Australian Doctor, headed 'GPs urged to "de-prescribe" in elderly' made the point that the number of medications taken by elderly patients had been shown to be an independent predictor of adverse drug events, drug interactions and hospitalisations.
'This article reminds us to be vigilant and gather information about all the medications our elderly patients are taking,' said Dr Colin Crook.
Dr Crook believes the GP needs to pause and think, 'does this patient still need this medication? What can they do without?'
'As GPs, we often find that our patients are receiving medications from other sources such as public hospital outpatients, specialists and even other GPs. Often as the primary doctor we hold information about our patients that other prescribers are not privy to. This can be particularly important when it relates to allergies or adverse reactions to other medications.'
Dr Colin Crook urges GPs to be vigilant about elderly patients' medication
Keeping Up-to-date With Medications
One useful way for the GP to keep up-to-date with an elderly patient's medications is by arranging for a Home Medicines Review (HMR Item #900) or a Residential Medicines Management Review (RMMR Item #903).
The pharmacist conducts the detailed review in the patient's residence. This review identifies and lists everything the patient is taking: all currently prescribed medication, over-the-counter preparations, alternative mixtures and supplements and out-of-date medications (or those prescribed for someone else).
The HMR reports have generated some hilarious and horrifying stories on unanticipated use of medicines, including sharing (with other humans and animals), mixing (with food and beverages), cooking, chilling, melting and microwaving medicines and bizarre misinterpretations about dosage and dose intervals.
If you can't be sure your patients understand and comply with sometimes complicated dosage guidelines it may be time for an HMR or RMMR.
For more information on HMR and RMMR contact Anna McIntyre at the Division annam@bddgp.org.au
Original article: GPs urged to 'de-prescribe' in elderly+
By Gabrielle Babbington
A considerable proportion of the elderly population are at risk of adverse events from multiple medications, but they often go unnoticed due to uncoordinated prescribing data, an Australian expert warns.
Associate Professor Michael Woodward, head of aged care at Austin Health in Melbourne, said about half of Australia's elderly population were on more than four medications and about 5% were on more than 20.
The number of medications an elderly patient took had been shown to be an independent predictor of adverse drug events, drug interactions and hospitalisations, he said.
Professor Woodward's comments came after a study he co-authored, published in the Internal Medicine Journal (February)++, showed a targeted feedback program to prescribers could reduce polypharmacy by about two medications per patient.
Using PBS data from the separately funded veteran's scheme, researchers identified patients being prescribed more than 19 medications each and sent their main prescribing GP dispensing information, relevant clinical guidelines and a personalised cover letter.
Professor Woodward said medications might cause rather than prevent hospitalisations.
He urged GPs to try to "de-prescribe" medications for their elderly patients, but said having multiple prescribers made this difficult.
"Many GPs don't know all the medications that their elderly patient is on because they're not the only prescriber. It becomes a fiasco — too many cooks overmedicate the broth," he said.
"It would serve health practitioners if they could access an updated list of what the patients are actually on."
This information could be used to send an alert to GPs when a patient accumulated a potentially dangerous number of medications, Professor Woodward said.
Research had demonstrated that polypharmacy increased over time without an intervention, he said.
+ Reproduced with permission from Australian Doctor, 7 March 2008 (p. 10)
++ Internal Medicine Journal 2008; 38:95-100. (abstract at http://www.blackwell-synergy.com/doi/abs/10.1111/j.1445-5994.2007.01453.x)
This article is available online at http://bddgp.org.au/article/2008/03/polypharmacy
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