A 20% increase in drugs dished out to older people is
mainly because of the ageing population rather than drugs being
overprescribed, the Ministry of Health says.
However, the ministry is considering a new health sector
performance measure on multiprescribing of drugs to older
Volumes of drugs dispensed to those over 60 increased 20%
between 2008 and 2013.
However, the total cost of medication for over-60s had
Ministry of Health chief medical officer Dr Don Mackie said
there had been only a small increase in the number of scripts
per patient between 2008 and 2013, suggesting much of the
increase was due to the ageing population.
However, multiprescribing to the elderly, known as
''polypharmacy'' in the health sector, was under scrutiny.
The ministry was ''actively considering'' including
multiprescribing in the Healthy Ageing system performance
measure for the health sector.
''Diseases and risk factors tend to accumulate with age, so
it is not surprising that medication of the elderly may
involve more medicines.
''However, evidence shows that the greater the numbers of
drugs that are prescribed to an individual, the greater the
risk of harmful interactions.
''As well, more medications means it can be harder to ensure
patients are taking the correct drug at the correct time,''
Dr Mackie said.
Quins Gore Pharmacy managing director Bernie McKone said New
Zealand needed to have a debate about prescribing, addressing
issues such as whether people in their 90s should be given
Mr McKone, a Southern Primary Health Organisation board
member, is helping to run a PHO pilot scheme in four
Southland general practices to reduce the number of
medications taken by the older patients who could benefit
from the approach.
Taking a ''holistic'' view, a multidisciplinary team was
looking at patient files and speaking to patients. It was a
difficult problem because ''socially we have taught New
Zealanders that the answer to every issue is a medicine''.
Families, doctors, and pharmacists needed to work together on
the issue, which had potential to create conflict and
differences of opinion.
''There's some debate that has to happen ... if we are going
to look at polypharmacy, we have to look at what are the
benefits of having those people on the medicines versus the
benefits of not having them on the medicines.''
When the Otago Daily Times contacted Mr McKone at his
pharmacy on Monday, he reviewed dispensing information from
that day, which showed one woman in her early 90s was on 14
Financial incentives made the problem worse, and there was
significant wastage in the system, he said.
A shift towards giving more people three months of medicine
in one go in the past couple of years was part of the
Reducing patient monitoring and dispensing controls was false
economy, he suggested.
''Some of our cheapest medicines cause the worst problems [in
terms of complications].''
Side effects in older people caused by too many medications
included renal failure, falls, and confusion.
• About one in four people aged 65-74 received five or more
long-term medicines in 2011.
• More than half those over 85 received five or more
long-term medicines in 2011.
• Frequency of adverse drug events increases with number of
• Rate of dispensing increases significantly with age.
• Big regional variations in use of some medications for
• High rates of benzodiazepines and antipsychotics
prescribing is causing concern.
Source: Health Quality and Safety