Medicine use related to ageing population

Don Mackie.
Don Mackie.
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 people.

Volumes of drugs dispensed to those over 60 increased 20% between 2008 and 2013.

However, the total cost of medication for over-60s had reduced.

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 statins.

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 permanent medications.

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 problem.

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.


Prescription drugs

• 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 drugs taken.

• Rate of dispensing increases significantly with age.

• Big regional variations in use of some medications for older people.

• High rates of benzodiazepines and antipsychotics prescribing is causing concern.

Source: Health Quality and Safety Commission


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