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THE INAPPROPRIATE PRESCRIBING of medications is linked to the increased hospitalisation of older people in Ireland, according to new research.
The studies, carried out by the Royal College of Surgeons in Ireland (RCSI) and the Health Research Board (HRB) in collaboration with researchers from Trinity College Dublin (TCD), examine the effects of potentially inappropriate prescriptions on people aged 65 and over.
The research found that the omission of some recommended medications from prescriptions is also linked with an increased risk of having to visit to an emergency department (ED).
The inappropriate prescription of medications was associated with a 29% higher rate of adverse reactions in the people studied. These symptoms were mainly mild, such as easy bruising, difficulty stopping bleeding from a small cut, heartburn and dizziness. There were a few relatively severe events that led to the hospitalisation of the patient.
The studies also found that healthcare use is higher among people who are taking more than one type of inappropriate medication, as well as those not being prescribed a potentially beneficial medicine. This was linked to an increase of approximately 15% in the rate of GP visits and of approximately 40% for ED visits.
The RCSI noted that older people are “particularly vulnerable to the adverse effects of medicines because of changes that occur with ageing in how the body processes and reacts to medicines”.
This age group is also at increased risk as they frequently have multiple chronic medical conditions and possible interactions between drugs they take to treat their multiple conditions.
Some of the most frequent types of medicines being prescribed included medication for gastric problems being prescribed to patients at high dosages for more than eight weeks and anti-inflammatory drugs being prescribed long-term or to patients with high blood pressure.
The research notes that the most frequent prescription omissions of potentially beneficial medicines were calcium and vitamin D supplements in patients with osteoporosis and the under-treatment of patients reporting an abnormal heart rhythm.
‘No single solution’
Dr Frank Moriarty of the HRB Centre for Primary Care Research at the RCSI said: “Our research shows that, despite there being justification for a patient being prescribed a potentially inappropriate medication, or whose prescription contains an omitted medicine, both lead to poorer outcomes for older patients.
At a time of unprecedented strain on our ED departments these findings are a reminder that a range of factors can contribute to a person’s risk of attending hospital. There is no single solution to this issue; however, facilitating effective management of older people’s conditions, specifically improving their medicines, in primary care may make a positive contribution.
The first study, published in the Journal of Gerontology, included more than 900 patients aged 70 years who were recruited from general practices in the greater Dublin area.
The second, published in the British Journal of Clinical Pharmacology, included approximately 1,700 medical card patients who were participating in The Irish LongituDinal Study on Ageing (TILDA), a national study led by TCD charting the economic, social and health circumstances of people over the age of 50.
Both studies followed participants over a two-year period with interviews and questionnaires.
Without access to notes or test results it is often impossible for community pharmacists to know if prescriptions are appropriate or not. Many hospitals are starting to address this by having pharmacists reviewing medication early in admissions but lots more needs to be done both in hospital and primary care.
@Ciara Dowling: in the piece the symptoms sound like blood thinners which are supposed to thin the blood to avoid clots. Perhaps being over prescribed which makes it difficult to operate on anyone who needs it. At the moment my mother aged 90 had an emergency pacemaker fitted yesterday in hospital thank goodness the only blood thinner she was on was a small amount of aspirin. Her husband who is over 100 is basically dying in a nursing home he has dementia and his body appears to be shutting down. As people are living to a greater age it is harder to know what to do with an ageing population who are increasing in numbers. As I am early 60 I guess I am in that group now but I don’t want to suffer from the illness of age.
So Doctors are prescribing the wrong drugs or the right drugs for longer periods than recommended and the pharmacists are just handing them out without checking.
Having a rare disease and addiction issues in the family,i have to be ultra cautious about the amount and type of drugs i take,my relationship with my pharmiscist is key, they aren’t like years ago and throwing out prescriptions,mine leads and guides like the professional she is ,unsung heroes
As a person who has a lot of ongoing health issues I take a fair amount of meds every day. The biggest issue I have over the last couple of years is that with generic meds taking the place of those prescribed by the GP I have to check and double check that I am taking the correct tablet relative to my various health problems. I take 5 different types of tablets a day and I can understand how a person with failing eye sight or just the effects of ageing could get mixed up with them. I regularly have to read the directions which are included in each box of tablets to make sure that I am taking the correct one and I have a fairly alert mind so I can well understand how mistakes could easily be made. What I do mostly now is, as soon as I get my meds I write on each box of tablets exactly what they are for.
With many GP practices being overcrowded and understaffed, the issuing of repeat prescriptions often falls to unqualified reception staff. Inappropriate medications may not be spotted. It is important that everyone visits their GP for check up and review at least twice a year. Although, for non GMS or GPV card holders it can be a financial burden. It’s vital that people use the same pharmacy regularly as mistakes and interactions are more easily spotted.
Also, since the introduction of the GMS prescription charge/levy many elderly patients cut back on things like Calcium and Vitamin D feeling they are not necessary. Many items that people had been used to getting on prescription are now no longer covered on any scheme.
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