Polypharmacy in the elderly: new project investigates

For many elderly Australians, a regimen of several prescription drugs is a daily fact of life. Over time, often beginning in middle age, health consumers can accumulate prescriptions to the point where they are using more medications than is medically necessary.

This phenomenon, known as polypharmacy, can have unintended and deleterious effects on an elderly consumer’s health, potentially leading to falls and cognitive impairment.

Professor Sarah Hilmer, from the University of Sydney School of Medicine, is on a mission to promote the 'deprescribing' of unnecessary drugs. She says inappropriate polypharmacy is almost universal amongst older public hospital inpatients but not addressed by routine care.

“There’s been a huge increase in the number of medicines available and people are starting to use them as preventative treatments in middle age and continuing them into old age,” says Professor Hilmer.

“As the consumer’s health changes over time, some of these treatments are no longer required, or become of low value. Compounding this is the issue of the prescribing cascade – doctors prescribing a drug to treat the effects of another drug, without realising they are doing so.”

In a translational research project funded by Sydney Health Partners, Professor Hilmer and her team are designing information to educate health consumers about inappropriate polypharmacy and the need to stop taking drugs that are no longer necessary.

“The whole idea of deprescribing is a relatively new field. The term was first coined in 2003 and clinician guidelines have only come out in the last five years or so. Providing consumers with guidelines is clearly the next step we have to take.”

Professor Hilmer, who is Head of the Department of Clinical Pharmacology and a Senior Staff Specialist in Aged Care at Royal North Shore Hospital, says that up until now, almost no written resources explicitly addressing the problem have been aimed at patients. She is collaborating with two University of Sydney experts in communicating with patients, Professor Parisa Aslani and Dr Jesse Jansen, to produce written resources, which target consumers.

“Our aim is that the information we develop will improve patient adherence to medication changes after they are discharged,” said Professor Hilmer.

“We need communications in which not only is the information logical and easy to understand but where the emotional message is clear - because when it comes to stopping drugs it’s not just about understanding the facts it’s also about feeling comfortable with them.”

The consumer resources developed through the project will be included in a bundle of interventions that aim to reduce inappropriate polypharmacy in older inpatients. These will be piloted at Concord and Royal North Shore Hospitals in the coming year.

“It’s not just doctors who need to know about the problem. If the consumer doesn’t know what is going on, then changes made in one part of the health system get lost as they move into the next part,” said Professor Hilmer.

“We will pilot the information we develop with consumers who are not currently taking prescription medicines and use questionnaires to test whether they can understand it, know what to do with it and, importantly, would be comfortable following it.”