2023-02-15

Abstract:

Frailty and polypharmacy are common in older people and both are associated with increased risk of negative outcomes such as falls, hospitalisation and mortality. Given that admission to hospital is an opportunity to comprehensively assess medical, psychological, and functional capabilities of older people, identification of frail patients during hospitalisation is important for prioritisation for specialised care. In addition, internationally, about 80% of older patients and their caregivers agree that they would be willing to stop one or more of their or their care recipient’s medications if the prescriber said it was possible. Therefore, deprescribing, which is a process of withdrawal of an inappropriate medication (one where the risks outweigh the benefits in the individual including high risk and unnecessary medications), supported by a healthcare professional with the goal of improving outcomes, is important in older people. In primary care, community pharmacists are one of the most accessible healthcare professionals and they are also generally the last healthcare professional who review patients’ capability of medication management before they start or continue taking their medicines. Community pharmacists therefore have a significant professional role in minimising drug-related harm and maximising the benefits of medicine use in older people. However, due to lack of the evaluation tools to measure care quality, there is likely much variability in the expertise of pharmacists providing care to older patients with polypharmacy, causing differences in the quality of care. In this seminar, I will present our latest study findings in relation to the following three questions: 1) how to measure frailty in older patients using routinely collected dataset in Australian hospitals? 2) how to facilitate deprescribing of inappropriate medications with sedatives and anticholinergic effects using the Drug Burden Index (DBI) as a clinical risk assessment tool? and 3) how to measure quality of care provided by pharmacists for older people with polypharmacy ?

References:

Fujita K, Lo SY, Hubbard RE, Gnjidic D, Hilmer SN. Comparison of a multidomain frailty index from routine health data with the hospital frailty risk score in older patients in an Australian hospital. Australas J Ageing. 2022; 00: 1- 11

Wu H, Kouladjian O’Donnell L, Fujita K, Masnoon N, Hilmer SN. Deprescribing in the Older Patient: A Narrative Review of Challenges and Solutions. Int J Gen Med. 2021 Jul 24;14:3793-3807.

Fujita K, Moles RJ, Chen TF. Quality indicators for responsible use of medicines: a systematic review, BMJ Open 2018;8:e020437. doi: 10.1136/bmjopen-2017-020437 Didion JP et al. PLoS genetics vol. 11,2 e1004850 (2015)