Introduction

The aging of the population, together with the resultant higher rates of chronic diseases and the increasing availability of therapeutic agents, have caused an increase in drug use among the elderly ¹.

The majority of older people take one or more medications daily to manage their multiple chronic conditions ² or lower health risk factors such as high cholesterol.

Medications include prescribed medications, over the counter drugs and complementary and alternative medicines such as vitamins, herbs and natural medicines ³.

Use of an increased number of medications is often associated with poor adherence, higher incidence of adverse drug reactions, suboptimal prescribing and high health care costs ³.

Definition

Polypharmacy, referring to a person taking four or more medications, occurs in over 40 per cent of older Australians ² In Malaysia, 39.2% of  elderly admitted to a medical ward in Government Hospital are taking  5 or more drugs.⁴.

A review on medication use in Australia found that on average older Australians take nine medications daily. This review also showed that predictors of multiple medications use include increasing age, female gender, the number of diagnoses, recent hospitalization and depression ³.

Some of the problems associated with medication use encountered by older people are ³:

• Inappropriate prescribing
• Polypharmacy and non-adherence
• Suboptimal monitoring of drugs
• Poor medication management at home (for example: storing medicines in unsuitable places)
• Under-prescribing
• Poor communication between health professionals.

Despite the perception that the number of medications is important, the type and dose of medications have a bigger impact in predicting clinical outcomes. The risks of suboptimal prescribing can be better measured using the drug burden index, which measures the people’s total exposure to certain medications and the effect of a particular type and dose of medication ⁴.

Medication management

Geriatrician involvement in multidisciplinary case discussions have been shown in a number of instances to be the most effective way to reduce inappropriate prescribing of medication; both in community and hospital settings. ⁵.

Medication adherence could be improved by having reminder packaging ⁶ or calendar packaging combined with education and reminder strategies ⁷.

The pharmacists at the health clinic will also counsel patient on information regarding:

• How a medicine works?
• How to take the medicines?
• Side effects of the medicine
• Interactions with other medicines
• Storage of medicines
• How to obtain consumer medicine information leaflets for your prescription medicine?
• Promotion of quality use of medicines and provision of information that is independent, evidence-based, appropriate and safe
• Encouraging responsible use of medicines by increasing public awareness about medicines.

Medications need to be reviewed regularly. This can be done by bringing all medicines on their visit to see their family doctor or pharmacist at the health Clinic or GP and assist in medicine management to:

• achieve safe, effective, and appropriate use of medicines by detecting and addressing medicine related problems that interfere with desired patient outcomes
• improve the patient’s quality of life and health outcomes using a best practice approach, that involves cooperation among the GPs, pharmacist, other relevant health professionals and the patient (and where appropriate, their caregiver)
• improve the patient’s, and health professional’s knowledge and understanding about medicines
• facilitate cooperative working relationships between members of the health care team in the interests of patient health and wellbeing.

Medication use among older people is complex. There are many facets to consider including age-related changes and multiple chronic conditions. Medication use should be tailored to individual needs and requires collaboration from the health care industry, physicians, pharmacists, nurses, care givers, and older person, and support from the health care system and regulatory authorities.

References

1. Elliott, R.A., Problems with Medication Use in the Elderly: An Australian Perspective. J Pharm Pract Res 2006. 36: p. 58-66.
2. Goldney, R.D. and L.J. Fisher, Use of prescribed medications in a South Australian community sample. Med J Aust, 2005. 183(5): p. 251-3.
3. Hilmer, S.N., et al., A drug burden index to define the functional burden of medications in older people. Arch Intern Med, 2007. 167(8): p. 781-7.
4. J.Y. Hor., Prescription drug use among elderly admitted to medical wards in a Malaysian government hospital, Med J Malaysia 2008. 63(2): p. 125-130
5. Kaur, S., et al., Interventions that can reduce inappropriate prescribing in the elderly: a systematic review. Drugs Aging, 2009. 26(12): p. 1013-28.
6. Mahtani, K.R., et al., Reminder packaging for improving adherence to self-administered long-term medications. Cochrane Database Syst Rev, 2011. 7(9): p. CD005025.
7. Stegemann, S., et al., Geriatric drug therapy: neglecting the inevitable majority. Ageing Res Rev,2010. 9(4): p. 384-98.
8. Zedler, B.K., et al., Does packaging with a calendar feature improve adherence to self-administered medication for long-term use? A systematic review. ClinTher, 2011. 33(1): p. 62-73.