More than one-third of Australians over 70 take five or more medications regularly, and while this is appropriate in many cases, a study out of Deakin University has revealed the potential harm caused by taking unnecessary medications.
According to Dr. Alemayehu Mekonnen, an Alfred Deakin Postdoctoral Research Fellow at Deakin University’s Institute for Health Transformation (IHT), medication-related harm is a leading cause of injury throughout the world, and much of it is preventable.
“Our recent study found that approximately two-thirds of older Australians were taking at least one medication that was unnecessary, or deemed to have an unclear indication when they were discharged from the general medicine wards of a tertiary care health service,” Mekonnen said in a Deakin University release on Friday.
Inappropriate prescribing has been closely associated with functional decline, falls, and a 91 percent increase in the likelihood of hospital admission resulting from medication-related harm, he said, adding that each year two to four percent of all hospital admissions in Australia are due to medication-related harm, which costs the Australian healthcare system $1.4 billion (US$940 million) a year.
A Complex Problem
Mekonnen stressed that to overcome the problem, recognising the complexities of medication-related harm is key.
‘Unsafe prescribing can be attributed to a number of things, including erroneous clinical judgement or under-recognition of risk when weighing the balance of benefit versus risk during prescribing medication selection, especially compared with suitable alternative medications,’ he explained.
“Another intricacy of medication-related harm is that the problems can go unnoticed,” Mekonnen said, noting that clinical manifestations of medication-related injury may not be easy to distinguish from the signs and symptoms of disease or may even be put down to the ageing process.
Meanwhile, Prof. Elizabeth Manias, IHT member and Associate Head of School (Research) in Deakin University’s School of Nursing and Midwifery, said communication breakdowns can also contribute to medication-related harm.
“There are missed opportunities throughout a patient’s care; a lack of teamwork, gaps in interprofessional communication, and poor coordination of care, especially when patients move from one health care setting into another, all contribute to medication-related harm,” she said.
Addressing Medication-Related Harm
While the issue of medication-related harm is complex, Deakin’s research shows it can be mitigated in several ways.
Manias stressed that transition of care programs could facilitate communication as patients traverse across care settings, such as moving from acute hospital care to rehabilitation.
Based on the research, at the time of patient transfer, attention is required to improve communication via effective clinical handovers, including enhanced communication between the different health professional disciplines involved in a particular patient’s care.
In addition, older patients should be encouraged to keep notes which would enable opportunistic discussions with health professionals, particularly if they lack confidence or their contributions are not considered important.
“Patients and their families should also be actively involved when it comes to prescribing medication. Being involved in the decision-making process is an important strategy to empower patients in their self-care,” Manias said.
Mekonnen added that “building suitable tools to support medication review and reconciliation practices can provide effective interventions to ensure the medications being prescribed are appropriate for the patient.”