Practice question

Why is medicines optimisation important for older people living with frailty?

Many older people living with frailty take multiple medicines. Medicines optimisation can help ensure such polypharmacy is appropriate, the best outcomes are achieved, waste is reduced and safety improved
Many older people use multiple medicines, medicines optimisation helps to ensure safe and appropriate polypharmacy

Many older people living with frailty take multiple medicines. Medicines optimisation can help ensure such polypharmacy is appropriate, the best outcomes are achieved, waste is reduced and safety improved

One quarter of people aged over 60 have two or more long-term conditions including frailty (National Institute for Health Research (NIHR) 2016).

Older people often have a number of co-existing medical issues and take multiple medications ( Milton et al 2008 ).

While this may include appropriate polypharmacy, evidence suggests that 30-50% of medicines prescribed for long-term conditions are not taken as intended

...

Many older people living with frailty take multiple medicines. Medicines optimisation can help ensure such polypharmacy is appropriate, the best outcomes are achieved, waste is reduced and safety improved

Many older people use multiple medicines, medicines optimisation helps to ensure safe and appropriate polypharmacy
​​Picture: Alamy

One quarter of people aged over 60 have two or more long-term conditions including frailty (National Institute for Health Research (NIHR) 2016).

Older people often have a number of co-existing medical issues and take multiple medications (Milton et al 2008).

While this may include appropriate polypharmacy, evidence suggests that 30-50% of medicines prescribed for long-term conditions are not taken as intended (Royal Pharmaceutical Society (RPS) 2013).

Medicine optimisation helps to ensure appropriate polypharmacy. By focusing on patients and their experiences, the goal is to:

  • Help patients take their medicines correctly.
  • Avoid taking unnecessary medicines.
  • Reduce wastage of medicines.
  • Improve medicines safety.

Four principles of medicines optimisation

Any approach should reflect the four principles of medicines optimisation outlined by the RPS (2013):

  1. Aim to understand the patient’s experience Establish a partnership between the practitioner and the patient using open dialogue. This requires advanced communication skills, empathy and confidence listening to and supporting patients with heightened levels of anxiety owing to their ill-health. Evidence shows that such approaches improve adherence and result in greater patient satisfaction (Cushing and Metcalfe 2007).
  2.  Evidence-based choice of medicines Ensure the most appropriate choice of clinically and cost-effective medicines, informed by the evidence base, that can best meet the patient’s needs. Tools available to help identify inappropriate prescribing in older people include: Beers Criteria (American Geriatrics Society Beers Criteria® Update Expert Panel 2019); STOPP/START criteria (O’Mahony et al 2015); and Medication Appropriateness Index (Hanlon et al 1992). Using a structured tool will help identify potentially problematic drugs including medications that increase the anticholinergic burden, benzodiazepines and Z-drugs (zopiclone and zolpidem), as well as medications for chronic pain management.
  3. Ensure medicines use is as safe as possible The safe use of medicines is the responsibility of all professionals, healthcare organisations and patients, and should be discussed with patients and/or their carers. When considering safety, the focus should include unwanted effects and interactions. Strategies should include dose adjustments, change of time of administration and switching to another medication (NIHR 2016). Deprescribing may be necessary and opportunities for lifestyle changes and non-medical therapies considered to reduce the need for medicines. Of emergency readmissions 6% or more are caused by avoidable adverse drug reactions so this approach is crucial (NIHR 2016).
  4. Make medicines optimisation part of routine practice Routinely discuss with colleagues and with patients and/or their carers how to get the best outcomes from medicines throughout the patient’s care (RPS 2013). Records about medications should be proactively shared. Some patients do not know how to take their medications and need advice and guidance. For example, a patient experiencing memory problems may be reluctant to acknowledge this. Never assume a patient is taking what you think they are (Payne and Duerden 2015).

Medicine optimisation is a patient-focused process that requires a holistic approach ensuring patients get the best outcomes from their medicines and ultimately reducing harm.


References


Author details

Sue Lyne is nurse consultant for frailty and older people, East Sussex Healthcare NHS Trust, email sue.lyne@nhs.net; Ceri McEwan is medicines optimisation pharmacist, East Sussex Healthcare NHS Trust, email ceri.mcewan1@nhs.net

Want to read more?

Subscribe for unlimited access

Enjoy 1 month's access for £1 and get:

  • Full access to nursingolderpeople.com
  • Bi-monthly digital edition
  • RCNi Portfolio and interactive CPD quizzes
  • RCNi Learning with 200+ evidence-based modules
  • 10 articles a month from any other RCNi journal

This article is not available as part of an institutional subscription. Why is this?

Jobs