14 Dec 2016
The Royal Australasian College of Physicians has released new recommendations on the appropriate use and prescribing of medicine for older Australians. Older Australians may not be aware they are on a ‘prescribing cascade’, where they take one medicine and have an adverse reaction, so are put on another medicine.
The new recommendations on appropriate use and prescribing of medicine include:
- recognising and stopping the prescribing cascade, to avoid adverse drug reactions in older people
- reducing the use of multiple medicines
- to not prescribe medicines without conducting a drug review, to avoid adverse outcomes for people on 5 to 20 medications, and
- to stop medicines when no further benefit will be achieved, particularly for older patients with a limited life expectancy where the treatments are unlikely to prevent disease.
An important issue to address
RACP President and The Australian and New Zealand Society for Geriatric Medicine member Dr Catherine Yelland said, “Care principles need to reflect the latest evidence and science, so that unnecessary tests, treatments and procedures are avoided. Equally important is the doctor-patient conversation to support informed and sound decision making to support high-quality care for older Australians.
Professor Jennifer Martin from the Australasian Society of Clinical and Experimental Pharmacologists and Toxicologists said: “One of our recommendations is to reduce the use of multiple medicines, common in older patients. Hyper-polypharmacy is where people may be on as many as 15 to 20 medicines at a time.
Research has confirmed a significant association between polypharmacy and adverse outcomes among older people and an association with decreased physical and social functioning; increased risk of falls, delirium, hospital admissions and death. With an ageing population, use of many medicines at the same time is something we need to be having conversations about to avoid potentially harmful implications.”
Read the recommendations