clinical focus
this takes it to the next level . We now need to look at risk-benefit ratios for prescribing of long-term preventative medications in aged care ,” Cooper says .
The research was funded via the Resthaven Incorporated Dementia Research Award through Alzheimer ’ s Australia Dementia Research Foundation .
Here , Cooper discusses the research in more detail with Aged Care Insite .
Fewer pills to swallow
Research suggests that reducing inessential medications may lessen the number and length of hospital stays among aged-care residents .
Tina Cooper interviewed by Dallas Bastian
Residents who take nine or more medications have an 89 per cent higher risk of hospitalisation than those taking fewer than nine , the authors of a new study say . Conducted by Monash University researchers and staff from Resthaven , the study set out to investigate whether there was an association between taking nine or more regular medications and admission to hospital .
The research team looked at residents ’ time to first hospitalisation , the number of hospitalisations , and the number of days spent in hospital over a 12-month period .
Tina Cooper ( née Emery ), executive manager of residential services at Resthaven , says the study has important implications for aged care and hospitals alike .
“ The research adds to the increasing body of evidence that suggests reducing the number of unnecessary or low-benefit medications , referred to as deprescribing , may be a valuable way to reduce unwanted , expensive hospital stays ,” Cooper says .
The study ’ s authors say it is important for clinicians to be alert to the risk of hospitalisation among residents with polypharmacy or complex medication regimens and to consider whether interventions such as ongoing medication reviews may be beneficial .
“ We have always advocated for frequent medication reviews , but
ACI : How common is it for residents to take nine or more medications , and why did Resthaven engage in this research ? TC : The study showed that of all the 383 residents we reviewed , 53 per cent were taking nine or more medications . The reason for the engagement on this topic is that it is quite apparent that the system at the moment is squeezed as far as hospital admissions , and if we can prevent unnecessary hospital admissions [ it is good ] for not only the acute care sector but also [ the resident involved ]. No one wants to go to hospital unnecessarily , so we felt this was an area we could work on and then consequently do some other work to see if we can reduce that 53 per cent .
What did the study reveal about the links between polypharmacy and hospitalisations ? It confirmed our thought that those people taking more than nine medications on a regular basis do have a higher association with transfer to hospital , for whatever reasons they might be . It showed that 89 per cent have a high risk of hospitalisation and have a higher number of hospital days . So , not only did they go to hospital more often , they stayed for longer .
What impact do you hope the findings have on Australian aged-care facilities ? Obviously aged-care providers are not the prescribers of medication , so … we must work with the GPs who are often the prescribers of these medications , and with our clinical pharmacists who undertake the medication reviews , to have those happen on a regular basis and have some outcomes to those reviews , in as far as what is able to be deprescribed for somebody that [ won ’ t ] have any marked effect on their health and wellbeing – medications that aren ’ t necessarily going to be a great benefit for that person at that stage in their life .
Other research we did told us the residents … are open to deprescribing , but they fear that they shouldn ’ t make that decision . Of course , they feel that the doctor should tell them that it ’ s okay . They want that reassurance .
What ’ s the best way to approach deprescribing ? The best way to approach it is that you do your medication reviews on admission , which the government funds us to do . Also , GPs can request further medication reviews when they ’ re clinically indicated . That ’ s a great opportunity for when there are other things happening for that person – a medication review can form part of an assessment to make decisions around changes and care need . Also , at Resthaven we make sure that deprescribing is a conversation we have with the residents and / or their representative at the time when we do their care evaluation .
Also , simple things like when medication charts are due for updating by the GPs , we have a discussion at that time with them about whether this is an opportunity to have a look at [ the resident ’ s ] medications for wherever the person is in their stage of their stay with us . ■ agedcareinsite . com . au 23