Quality not quantity in medicating aged-care residents

Greater levels of pharmacist intervention are required when administering drugs to an “overly-medicated” elderly population, the Royal Commission into Aged Care Quality and Safety interim report revealed last week.

The average Australian aged-care resident takes 9.75 medicines, and an estimated 30% of hospitalisations in older Australians are the result of medication-related harm; yet the need for ongoing consumption of pharmaceuticals is not routinely reviewed by some aged-care facilities.

This means that drugs like antibiotics, antidepressants and other medications with harmful side effects, are often taken unnecessarily on a long-term basis, doing more harm than good.

The Society of Hospital Pharmacists of Australia (SHPA) welcomes the recommendation and says that better intervention will improve quality of life for aged-care residents.

“We have a responsibility to ensure that elderly people are living comfortably and are free from undue risk of harm,” said SHPA CEO Kristin Michaels.

“Few medications come without side effects, and some of these can be serious.

“Great care is usually taken in writing initial prescriptions, yet we are not often seeing the same levels of care in managing the trajectory of the ailment, even though this is just as important.

“It’s vital that pharmacists’ expertise is harnessed to check in regularly and see if symptoms are clearing up or getting worse, either changing or altogether stopping the medication if appropriate.”

Medication-related problems in aged care are far-reaching and can be severe.

Prolonged, inappropriate use of psychotropic medicines for chemical restraint and dementia symptoms are associated with cognitive decline.

Prolonged, inappropriate use of proton pump inhibitors are linked to hip fractures.

Underdosing with anticoagulants can increase the risk of stroke, while overdosing can precipitate bleeding.

And modified- or extended-release medicines, such as opioids or diabetes medications, being crushed before administration can cause unintentional overdoses.

SHPA advocates monthly medication reviews to assess symptoms and make better informed decisions about the ongoing usage of drugs.

“Pharmacists are our trained and equipped medicines experts. Ideally, we’d like to see more pharmacist services embedded in aged-care facilities, rather than relying on external parties,” Michaels said.

“This would encourage greater ongoing intervention and better reflect the severity of the issue.

“We’re aware that some facilities do have this level of support in place already, but it should really be a mandatory requirement across the sector.”

Michaels believes channelling funds into a new model of care that supports greater pharmacist intervention will save more money in the long term.

“It’s preventative,” she said. “And on that basis, I see it as a bit of a ‘no brainer’. It may be an added expense, but we can’t afford not to finesse the system and ensure we are not inappropriately medicating people,” she concluded.

Image credit: ©stock.adobe.com/au/DedMityay