MEDICAL MATTERS:Polypharmacy can reduce effects of medication, writes MUIRIS HOUSTON
SIR WILLIAM Osler, the famous Canadian doctor, may or may not have had tongue in cheek when he advised: “One of the first duties of the physician is to educate the masses not to take medicine.”
But he would certainly be shaking his head at the results of the study published last week by the Centre for Ageing Research and Development in Ireland (CARDI), which found that seven out of 10 older people in nursing homes in Ireland are getting at least one inappropriately prescribed medicine.
The cross-Border research led by Dr Stephen Byrne, senior lecturer in clinical pharmacy at University College Cork, found that 630 older people in long-term care in Northern Ireland and the Cork area were receiving an average of 11 medicines each. Half of them were prescribed between eight and 14 drugs. Overall, almost one-fifth of those studied were receiving three or more potentially inappropriate medicines.
Benezodiazepines – used for anxiety and sleep problems – were the most common potentially inappropriately prescribed medication, according to the researchers. Among the drugs that cause the greatest side effects in older people are sedatives. Over-sedation, confusion and falls are a common result.
Polypharmacy – the simultaneous prescribing of multiple drugs – is common in the older population. More than 85 per cent of older people take at least one type of medication leading to potential drug interactions. When certain drugs mix in the body, one of the drugs may become more potent or even toxic. The reduced effectiveness of a drug because of an interaction is also a risk.
A patient taking six or more types of drugs a day is estimated to have an 80 per cent risk of a drug interaction. One of the reasons for this is that kidney function is often impaired in older people, which affects the ability of the body to excrete drugs. The natural diminution in the function of other key organs such as the heart and liver, as well as the natural depletion of several hormones, means that older patients’ response to medication can be very different.
As the advocacy group Age Action pointed out, the high level of inappropriate prescribing in the latest study was among nursing home residents where three-monthly reviews are required under standards laid down by the Health Information and Quality Authority (Hiqa). But what about the majority of older people who live in the community?
With the number of people aged 65 and over still rising and predicted to reach 24 per cent of the population by 2030, and with the “old old” – those aged 85 years and over – growing at the fastest rate of all, prescribing issues for older people are set to become even more crucial to maintaining optimum health.
The European Union Geriatric Medicine Society is promoting appropriate licensing and prescribing of medications as a key initiative for 2011. Its president, Tallaght hospital consultant Prof Des O’Neill, says older people use more than 30 per cent of prescribed medicines, and more than 40 per cent of over-the-counter medicines. Despite this, says O’Neill, “older people are still generally excluded from clinical trials; medicines are not developed for their specific use in older people. The profound neglect of tailoring medicines testing and licensing to the more complex needs of this major group may be seen as a form of institutional elder abuse . . . ”
Here are some tips to help reduce the risk of unwanted drug side effects:
Never take medication which is a different colour, shape or size to your regular tablets without first checking with your pharmacist.
If you develop new symptoms within days of taking new medication, contact the doctor who prescribed it to discuss stopping the drug.
Read the information leaflets which come with your medication. This will tell you about potential drug interactions and side effects.
If you or an older relative are taking an assortment of drugs, discuss the possibility of reducing the number of medications at your next consultation.