Medicines management: How can we prevent older people from taking too many medicines?
Extending consultation times could enable practitioners to explore medication usage in more depth, says Matt Griffiths.
Question: How can we prevent older people in the community from taking too many medicines inappropriately?
A recent study from researchers at Ghent University in Belgium, involving 503 community-based adults aged 80 and over, found that 58% were taking five or more long-term medications daily, but few were taking them appropriately; underuse occurred in 67% of those studied and misuse occurred in 56%, with some overlap.
These findings echo previous studies carried out in the UK, which have shown that the average 80-year-old takes eight different kinds of medicines daily, and that medicines used for long-term conditions are only taken correctly by about 50% of patients.
So why is this happening? All medicines have side effects and, because older people often have reduced renal and hepatic function, some medicines can cause significant problems. Older people can also become confused, so complex administration regimes for multiple medications can increase poor adherence.
Formal medicines review
Older patients often won’t admit to not taking their medicines as prescribed for fear of damaging the nurse/doctor-patient relationship, and it can be difficult to monitor how medicines are taken in the community because we are not in patients’ homes to see how many are being stockpiled.
Prescribing and monitoring medicines is complex, especially in older people, and the only way to know what patients are taking is to carry out a formal medicines review. But this takes time, which can be difficult given the short appointment times available these days.
Perhaps we should be extending consultation times for older people so we can explore their medication usage in more depth. This could help reduce harm to patients, meaning fewer medicines-related hospital admissions, and cut the cost of wasted medicines to the NHS.
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