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

Abstract

Objective

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

Acknowledgments

The authors would like to thank Elena Klestov and Eamonn Eeles, participating geriatricians for their support during the video-consultation; Melinda Martin Khan, research fellow in Centre for Research in Geriatric Medicine, for her help in ethics application; and staffs in Masonic Care Queensland for their assistance in data collection phase of this study. An abstract of preliminary study results on the first 75 patients was accepted as a poster in British Geriatrics Society (BGS) Autumn Meeting 2014, 15–17th October, Brighton, UK.

Disclosure

The authors report no conflicts of interest in this work.