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Make NSAIDs a ‘last resort’
Overuse of NSAIDs putting
residents at risk.
R
esearchers have found that NSAIDs,
such as common ibuprofen, are
being overused in aged care,
putting residents at risk.
The study – which looked at more than
10,000 residents during a three-year period
– also found that the “triple whammy use”
of oral NSAIDs, ACE inhibitors and diuretics,
while rare, carries an increased risk of acute
kidney injury.
Research co-author Kim Lind said pain
and arthritis-related pain are the most
common reasons for oral NSAID usage,
and as they are often available over the
counter, these drugs are seen as unlikely
to be dangerous.
“We don’t want to see people on it
for more than two weeks. That’s what
Choosing Wisely Australia recommends,”
Lind said.
Don’t scrimp, stupid
Saving money on aged care
food a ‘false economy’.
W
hile keeping food spend low
in aged care might seem like
a cost-saving measure, it’s
actually a false economy.
That’s one of the messages Dr Sandra
Iuliano, who provided evidence at the aged
care royal commission, sent to the sector
via an article published in the University of
Melbourne publication Pursuit.
Iuliano explained that malnutrition
actually leads to higher costs as residents
become frailer and more dependent.
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agedcareinsite.com.au
“It leaves them at greater risk of suffering
pressure sores or a fall, and reduces
people’s immunity generally,” she said.
“Any hospital stay will be lengthened,
which is why malnutrition is estimated
to add nearly $1800 to the cost of each
hospital admission. That is over and above
the cost of the treatment for the condition
for which that person was originally
admitted to hospital.”
Research by Iuliano and her colleagues
looked at 21 aged care facilities in
Melbourne and found that 68 per cent of
residents were malnourished or at risk of
malnutrition.
“Typically, the facilities we researched
worked to a four-week rotating menu,
Lind’s research showed that some
residents with very severe pain had NSAIDs
prescribed for the duration of their stay in
aged care, which could amount to years.
Although the research did not analyse
mortality in relation to the medication use,
Lind argued that overuse of the NSAIDs are
likely to contribute to a resident’s decline
without being noticed.
“It could be that somebody gets some
medication, they start doing poorly, they may
go to the hospital, and I think providers are
not always quick to notice that it’s just due to
the medication combination, and that’s why
the person is having kidney failure.”
Lind argued that facilities should be
exploring and exhausting all available
treatment options, moving away from over-
reliance on NSAIDs and other medications.
Exercise and physiotherapy are often
the best medicine, Lind said, and NSAIDs
should be seen as a “last resort”.
Going forward, better regulation and
oversight of medications is needed in
aged care, and government and business
need to work together to incorporate data
tracking technologies, Lind argued. ■
usually consisting of a continental-style
breakfast; a midday meal of a hot dish
and dessert; an evening meal of soup, a
choice of a hot or cold dish, and a dessert;
along with morning and afternoon tea
and snacks,” she said, and added this
was providing residents with a daily
average equivalent to just one serving of
a high-protein food, compared with the
recommended two servings per day.
Iuliano said unless families are regularly
bringing in food for their loved ones,
residents have limited opportunity to
access other foods.
And, as the daughter of a Wollongong
aged care resident attested to at a recent
royal commission hearing, even the food
brought in by family members isn’t always
meeting its aim.
Much of Iuliano’s research has assessed
practical ways to improve nutritional care
for residents by changing the food they’re
offered, rather than relying on adding
nutrient supplements.
“Once the outcomes of the royal
commission are announced, which
hopefully will acknowledge the importance
of food and nutrition in the health of aged
care residents, the goal should be to equip
staff with the knowledge and know-how
to improve nutritional intake of the older
adults in their care,” she said. ■