Polypharmacy on the rise

elderly couple silhouette made from pills

The number of Australians aged 70-plus taking at least five medicines a day has crept up to nearly a million – and pharmacists are in a good position to help them make good decisions

A new study led by the University of Western Australia in collaboration with the University of New South Wales, and published in the Medical Journal of Australia, examined the prevalence of polypharmacy among Australians aged 70 and over between 2006 and 2017.

It analysed a random 10% sample of PBS data for people in this age group, who were dispensed PBS-listed medicines between 1 January 2016 and 31 December 2017.

While the authors note that there is no universally accepted definition of polypharmacy, current working definitions include four or more daily medicines (applied by the World Health Organization), or five or more concurrent medicines, as well as qualitative definitions such as “more medicines than necessary”. The authors applied several definitions to determine the extent of polypharmacy among older Australians in the relevant period.

“We estimated continuous polypharmacy by counting the number of unique medicines dispensed during both of two time periods, 1 April – 30 June and 1 October – 31 December, in each calendar year; we separately counted each active ingredient in combination preparations,” they wrote.

“This measure of polypharmacy captures prescription medicines taken on a regular basis. We chose the specified exposure periods to avoid underestimating medicine exposure because people who reach the PBS ‘safety net’ stockpile medicines at the end of the calendar year (once the total amount paid for medicines by an individual or family reaches a threshold level, further medicines can be acquired with reduced or [for concessional beneficiaries] without co-payments).

“Our primary outcome was the prevalence of continuous polypharmacy of five or more unique medicines; as secondary outcomes, we report continuous polypharmacy of ten or more and 15 or more unique medicines.”

UWA Centre for Optimisation of Medicines Dr Amy Page, who led the study, said that she and her colleagues found a 52% increase in the number of people taking at least five medicines between 2006 and 2017, rising to 935,240 people in 2017.

People aged in their 80s were most likely to take at least five medicines a day.

“The number of concessional beneficiaries in the PBS sample aged 70 years or more was 163,725 in 2006 and 229,212 in 2017. The estimated number of people affected by polypharmacy with five or more unique medicines increased from 543,950 (prevalence, 33.2%) in 2006 to 829,830 (39.8%) in 2014, then declined to 814,470 (36.8%) in 2016 before rising to 828,950 (36.2%) in 2017; the overall increase in absolute numbers during 2006–2017 was 52%,” the paper states.

“The estimated number of older concessional beneficiaries affected by hyperpolypharmacy increased from 71,550 in 2006 (prevalence, 4.1%) to 139 650 (6.1%) in 2017, an absolute increase of 95%.

“The proportion of older Australians (general and concessional beneficiaries) affected by cumulative polypharmacy with five or more unique medicines in 2017 was 52.7%, corresponding to an estimated 1,366,590 people; this number is our upper estimate of polypharmacy among older Australians.

“Among concessional beneficiaries, annual estimates of the prevalence of cumulative polypharmacy were consistently higher than for continuous polypharmacy, but the changes over time were similar.”

Dr Page told the AJP that “it is important to realise that polypharmacy may be appropriate for some people”. 

“The use of medications is particularly important for symptom control and disease progression in older people,” she said.

“Appropriate medication therapy is they key – under-treatment means that older people can miss out on the potential benefits of useful medications, while over-treatment puts them at increased risk of harm.”

In a media release, she also noted that the medicines she and her colleagues looked at did not include OTC medicines; vitamins, supplements or herbal medicines; or any medicines not funded by the PBS.

“Strategies to increase people’s understanding of the potential risks involved in talking multiple medications are needed that target both health professionals and the public,” Dr Page said.

“Taking multiple medications may be necessary, but it needs to be carefully assessed by a medical professional and balanced against the potential risks.”

She also told the AJP that pharmacists have an important role to play in ensuring the appropriate use of medications. 

“Pharmacists are in a good position to see all the medications that people take – private scripts, PBS scripts, OTC medications, vitamins, minerals and herbs. 

“These all contribute to the overall medication use. We need to be supporting people to make appropriate decisions about non-prescription medications.”

After the study received significant coverage through mainstream media outlets including Fairfax, NPS MedicineWise issued four tips on helping Australians keep on top of their medicines.

  1. Keep a medicines list: “Keeping a written list of your medicines is a great way to keep track of the medicines you are currently taking and why you are taking them,” says the NPS. “Remember to note the active ingredient of the medicine, what it is for, the dose and when to take it. Share and update your medicines list with your health professional when you change your medicines.”
  2. Use the MedicineWise app: “The MedicineWise app helps keep track of your medicines. It can store a list of your medicines, schedule reminders and provide information on your medicines. It can also help people who care for loved ones who use multiple medicines.”
  3. Call the Medicines Line: The Medicines Line is a free service from NPS MedicineWise providing consumers with information from health professionals on prescription, over-the-counter and complementary medicines. Consumers can call 1300 MEDICINE (1300 633 424) for the cost of a local call on Monday–Friday 9am–5pm AEST (excluding public holidays).
  4. Ask your health professional if you have any questions: “Using your medicines properly is the best way to get the most out of your medicines, safely,” says NPS MedicineWise. “If there is something you don’t know or don’t understand, or if you haven’t checked when something changes with your medicines, then you need to ask. Asking your health professional any questions you may have is the best way to get the most out of your medicines.”

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  1. John Wilks

    The most immediate solution is to lift the cap on HMRs

  2. Andrew

    This is getting silly. Yet another study showing polypharmacy isn’t being appropriately supervised in Australia. The efficiency report on HMRs the guild promised (in the first half of the decade, FFS) is nowhere to be seen. We are fundamentally abrogating our QuM obligations by not advocating in the strongest terms for this kind of service and the guild is solely responsible for the unavailability of this option. Again, commercial interest over public health.
    The process is not suitable in a retail environment as not all pharmacists are qualified for the role. Accessibility should be paramount and an algorithm based on the major risk factors should automatically trigger a review by an appropriately qualified clinical pharmacist
    Evidence based practice please. Or just keep selling perfume. I don’t care any more tbh.

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