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

Poudel, Arjun, Peel, Nancye M., Mitchell, Charles A., Gray, Leonard C., Nissen, Lisa M., & Hubbard, Ruth E. (2015) Geriatrician interventions on medication prescribing for frail older people in residential aged care facilities. Clinical Interventions in Aging, 10, pp. 1043-1051.

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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.

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ID Code: 91862
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: frail older, geriatrician intervention, high-risk medications, residential aged care facilities
DOI: 10.2147/CIA.S84402
ISSN: 1178-1998
Divisions: Current > Schools > School of Clinical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Copyright Owner: Copyright 2015 Poudel et al.
Copyright Statement: This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution – Non Commercial (unported, v3.0) License. The full terms of the License are available at Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. Permissions beyond the scope of the License are administered by Dove Medical Press Limited. Information on how to request permission may be found at:
Deposited On: 14 Jan 2016 00:14
Last Modified: 14 Jan 2016 22:16

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