Pharmacists key to managing polypharmacy in elderly

dementia-friendly communities: older hand held by younger hands

Medication reconciliation service ranks highest out of 16 potential interventions

Polypharmacy, or the use of nine or more medicines, is highly prevalent in Australian residential aged care facilities and contributes a significant burden to residents, staff and the healthcare system.

Natali Jokanovic and colleagues from the pharmacy departments at Monash University and Alfred Hospital in Melbourne have worked on several studies covering polypharmacy in aged care facilities over the past few years.

The latest, published in Research in Social & Administrative Pharmacy, looks at interventions that could best help to manage the issue.

It has identified 16 potential interventions and ranked them in order of importance.

Pharmacist-led medication reconciliation service for new residents to residential aged care facilities ranked highest.

According to the study, evidence shows pharmacist-led medication reviews in the primary care setting results in significant reductions in the mean number of medications and drug-related problems.

“This suggests medication reconciliation should be performed soon after residents are admitted to the facilities. A complete medication list is a key initial step in the deprescribing process,” says Jokanovic.

Other highly ranked interventions in the study included the development of deprescribing scripts to assist clinician-resident discussion, and the development or revision of prescribing guidelines specific to older people with multimorbidity.

“Clinical practice guidelines are currently disease-specific and rarely provide guidance for older people with multimorbidity in residential aged care facilities,” explains Jokanovic.

“Strict blood glucose or blood pressure control targets that are not specific to [this group] may contribute to polypharmacy.

Facility audits and feedback to staff and healthcare workers ranked second out of the potential 16 interventions, highlighting the need for educating staff on high-risk and/or highly prevalent medication.

Meanwhile, the implementation of electronic medication charts and records ranked fifth.

There are a variety of reasons the prevalence of polypharmacy in aged care facilities is high and increasing.

Jokanovic and colleagues found one of the top factors was increasing numbers of prescribers and the reluctance of particular prescribers to discontinue a medicine commenced by another prescriber.

There has also been greater recognition and pharmacological management of pain in the elderly. The prevalence of pain among residents in aged care facilities is reportedly as high as 80% in some facilities.

For more information:

Prioritizing interventions to address polypharmacy in Australian aged care facilities

Why is polypharmacy increasing in aged care facilities? The views of Australian health care professionals.

Prevalence and Factors Associated With Polypharmacy in Long-Term Care Facilities: A Systematic Review

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