Optimising medication use in older adults
2 April 2022
The Malaysian population is ageing rapidly, and its healthcare needs are changing. By 2056, adults over 65 will make up 20 per cent of the Malaysian population. Many older adults take different medications to reduce symptoms, manage their condition, improve quality of life, and reduce mortality. However, when used longer than needed, some medicines or taken together can be dangerous, increasing the risk of drug interactions. This problem, coined as "potentially inappropriate medications", describes the condition when medicine results in more harm than benefits.
"This problem can cause older adults to be at a higher risk of adverse events, such as the increased risk of falls, hospitalisation, and death. Our research showed that nearly one in every five older adults living in nursing homes has potentially inappropriate medication. We conducted the study among older adults that were living in nursing homes. We used the Screening Tool of Older Person's Prescriptions (STOPP-2) and 2015 Beers criteria to identify inappropriate medicines. We had chosen both tools since they include a list of drugs prescribed without an evidence-based clinical indication and any drugs prescribed beyond the recommended duration. A team of pharmacists reviewed 155 older adults taking 503 medications and 85 supplements. We found that 21.3 per cent of older adults had been prescribed at least one potentially inappropriate medication, especially among those with mental health issues and those who took five or more medications," stated Associate Professor Dr Shaun Lee Wen Huey from the School of Pharmacy, Monash University Malaysia.
Therefore, older adults must have their medications regularly reviewed by a pharmacist. If necessary, the inappropriate medications are removed or deprescribed. Dr Lee and his team worked with several nursing homes to examine if weaning older adults off unnecessary medication can lead to better outcomes. The research team started to identify inappropriate drug use through a medication history review, followed by an assessment of any drug-drug and drug-food interactions to reduce the risk of adverse drug events. The pharmacist involved in the study then discussed the feasibility of reducing these medicine for these older adults with the healthcare provider and monitored their response.
"In a cluster randomised study among 295 residents, we found that this deprescribing program can be helpful to reduce the risk of mortality and hospitalisation. We observed a reduction in the total number of medications among these older adults. We could conservatively save US $4,168.30 (RM 17,136) for each older adult," Dr Lee shared.
Most of these drug-related problems are often associated with the inappropriate use of medicines for gastrointestinal disorders such as gastric reflux, anticholinergics and painkillers. Given these results, the critical question is, are older adults willing to reduce their medications?
"In another study I worked on, we used the revised Patients' Attitudes Towards Deprescribing (rPATD) questionnaire to explore the willingness to deprescribe medications in older adults. We found that 68 per cent of older adults reported willingness to stop ≥1 of their medications if their doctor indicated that this was possible, in line with the findings from other studies using this questionnaire. Almost 90 per cent of the older adults reported being satisfied with their current medication intake. Hence, this suggests that we should also listen to the voices of older adults and consider their opinions," Dr Lee said.