Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities

Arjun Poudel,1 Nancye M Peel,2 Charles A Mitchell,1 Leonard C Gray,2 Lisa M Nissen,1,3 Ruth E Hubbard21School of Pharmacy, 2Centre for Research in Geriatric Medicine, The University of Queensland, 3School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, AustraliaObjective: I...

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Autores principales:	Poudel A, Peel NM, Mitchell CA, Gray LC, Nissen LM, Hubbard RE
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2015
Materias:	frail older geriatrician intervention high-risk medications residential aged care facilities Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/ff5cc9a2e5484208ad53d3f692e78c36
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spelling	oai:doaj.org-article:ff5cc9a2e5484208ad53d3f692e78c362021-12-02T07:23:18ZGeriatrician interventions on medication prescribing for frail older people in residential aged care facilities1178-1998https://doaj.org/article/ff5cc9a2e5484208ad53d3f692e78c362015-06-01T00:00:00Zhttps://www.dovepress.com/geriatrician-interventions-on-medication-prescribing-for-frail-older-p-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Arjun Poudel,1 Nancye M Peel,2 Charles A Mitchell,1 Leonard C Gray,2 Lisa M Nissen,1,3 Ruth E Hubbard21School of Pharmacy, 2Centre for Research in Geriatric Medicine, The University of Queensland, 3School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, AustraliaObjective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference.Design: This is a prospective observational study.Setting: Four RACFs in Queensland, Australia, are included.Participants: A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation.Results: Residents’ mean (standard deviation, SD) age was 83.0 (8.1) years and 64.1% were female. They had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean (SD) of 9.6 (4.2) regular medications. Ninety-one percent of patients were taking five or more medications daily. Of total medications prescribed (n=1,469), geriatricians recommended withdrawal of 9.8% (n=145) and dose alteration of 3.5% (n=51). New medications were initiated in 47.7% (n=73) patients. Of the 10.3% (n=151) medications considered as high risk, 17.2% were stopped and dose altered in 2.6%.Conclusion: There was a moderate prevalence of potentially inappropriate high-risk medications. However, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients. Further research, including a broader survey, is required to understand these dynamics.Keywords: frail older, geriatrician intervention, high-risk medications, residential aged care facilitiesPoudel APeel NMMitchell CAGray LCNissen LMHubbard REDove Medical Pressarticlefrail oldergeriatrician interventionhigh-risk medicationsresidential aged care facilitiesGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 10, Pp 1043-1051 (2015)
institution	DOAJ
collection	DOAJ
language	EN
topic	frail older geriatrician intervention high-risk medications residential aged care facilities Geriatrics RC952-954.6
spellingShingle	frail older geriatrician intervention high-risk medications residential aged care facilities Geriatrics RC952-954.6 Poudel A Peel NM Mitchell CA Gray LC Nissen LM Hubbard RE Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
description	Arjun Poudel,1 Nancye M Peel,2 Charles A Mitchell,1 Leonard C Gray,2 Lisa M Nissen,1,3 Ruth E Hubbard21School of Pharmacy, 2Centre for Research in Geriatric Medicine, The University of Queensland, 3School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, AustraliaObjective: In Australian residential aged care facilities (RACFs), the use of certain classes of high-risk medication such as antipsychotics, potent analgesics, and sedatives is high. Here, we examined the prescribed medications and subsequent changes recommended by geriatricians during comprehensive geriatric consultations provided to residents of RACFs via videoconference.Design: This is a prospective observational study.Setting: Four RACFs in Queensland, Australia, are included.Participants: A total of 153 residents referred by general practitioners for comprehensive assessment by geriatricians delivered by video-consultation.Results: Residents’ mean (standard deviation, SD) age was 83.0 (8.1) years and 64.1% were female. They had multiple comorbidities (mean 6), high levels of dependency, and were prescribed a mean (SD) of 9.6 (4.2) regular medications. Ninety-one percent of patients were taking five or more medications daily. Of total medications prescribed (n=1,469), geriatricians recommended withdrawal of 9.8% (n=145) and dose alteration of 3.5% (n=51). New medications were initiated in 47.7% (n=73) patients. Of the 10.3% (n=151) medications considered as high risk, 17.2% were stopped and dose altered in 2.6%.Conclusion: There was a moderate prevalence of potentially inappropriate high-risk medications. However, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. A structured medication review using an algorithm for withdrawing medications of high disutility might help optimize medications in frail patients. Further research, including a broader survey, is required to understand these dynamics.Keywords: frail older, geriatrician intervention, high-risk medications, residential aged care facilities
format	article
author	Poudel A Peel NM Mitchell CA Gray LC Nissen LM Hubbard RE
author_facet	Poudel A Peel NM Mitchell CA Gray LC Nissen LM Hubbard RE
author_sort	Poudel A
title	Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
title_short	Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
title_full	Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
title_fullStr	Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
title_full_unstemmed	Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
title_sort	geriatrician interventions on medication prescribing for frail older people in residential aged care facilities
publisher	Dove Medical Press
publishDate	2015
url	https://doaj.org/article/ff5cc9a2e5484208ad53d3f692e78c36
work_keys_str_mv	AT poudela geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities AT peelnm geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities AT mitchellca geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities AT graylc geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities AT nissenlm geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities AT hubbardre geriatricianinterventionsonmedicationprescribingforfrailolderpeopleinresidentialagedcarefacilities
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Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities

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