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Doctors urged to focus on reducing prescriptions for older Australians -

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ELEANOR HALL: Researchers are warning today in the Medical Journal of Australia that one in five drug prescriptions to older adults is inappropriate and in some cases unnecessary, and they're recommending that doctors "deprescribe".

One of the authors is Associate Professor Ian Scott from the Princess Alexandra Hospital in Brisbane.

He spoke to Alison Caldwell.

IAN SCOTT: I think that in older people, they have a number of co-morbidities, a number of diseases that often require multiple drugs to be prescribed.

So folk who are living in the community who are reasonably independent, they can average about six drugs per person.

The people who live in nursing homes can average about seven. Folks who are actually hospitalised with illness, they average about eight.

So we're saying that in most older patients, they're certainly taking more than five drugs.

ALISON CALDWELL: There must be a number of risks associated with that, I would've thought?

IAN SCOTT: Yes there are. Certainly there are risks of side effects; there are risks of interactions between the drugs themselves.

Some drugs can interact with each other and cause more problems, and also certain drugs aren't necessarily well accommodated by older people with certain diseases like kidney failure, liver failure, heart failure, and who may have some degenerative neurological diseases as well.

So the drugs always have to be kept in context in terms of what their effects are.

ALISON CALDWELL: And is it the case that sometimes some of these drugs just aren't even needed anymore?

IAN SCOTT: That's correct. We think that about one in five medications are probably not justified on the basis that the original indication no longer exists.

The problem, perhaps even the disease that the patient was originally prescribed the drug now has resolved or gone into full remission and therefore perhaps the medication can be then withdrawn.

In other cases, we think the drugs are not a particularly good choice in that particular patient, given their particular health problems and given what other drugs they may already be taking.

ALISON CALDWELL: You talk about "deprescribing". That, I would imagine, would be fraught with difficulties?

IAN SCOTT: Oh yes. This is not an easy task but I think it's become more urgent, a challenge that we have to meet I think, because the burden of harm and indeed just the costs of hospitalisation of patients due to drug-related problems is now becoming quite significant.

So I think that we've been aware perhaps of the problem for a little while but there hasn't been a coordinated and systematic effort to actually tackle the problem.

So yes, there are challenges and I think the first and foremost is health professionals, that is, prescribing doctors but also clinical pharmacists and others, I think need to take the time and make the commitment to regularly reviewing the medication lists of all older patients and asking themselves, are all these drugs still needed.

ALISON CALDWELL: We constantly hear about GPs being overworked and overstretched; pharmacies are changing in Australia. How many older Australians get continuing support from the one GP, the one pharmacist, who can keep an eye on these things for them?

IAN SCOTT: I agree, it's a challenge and there's no doubt continuity of care is paramount.

And I think perhaps patients themselves may have to lobby and argue that they would like a single person to take more charge of their care and certainly taking more charge of looking at their medication list more regularly.

So perhaps patients have to advocate for this as well, but I think nevertheless there is professional responsibility to ensure that people are being cared for by someone who really gets to know them and understand their diseases and the problems that they may be encountering with their drugs.

There are I think Medicare items though that GPs can use to spend a bit of time looking at people's medication lists.

There are extended care items, there are health assessment items for 75-year-old patients and older where you can spend some time, and I think if you dedicate some of those consults to specifically looking just at medication list and having a good hard think about what we perhaps could stop and discussing that with patients and getting their views on the matter - because when patients do get the opportunity to talk, many of them are more than happy to have some of their drugs removed - then I think that's what we should do more of.

ELEANOR HALL: That's Associate Professor Ian Scott.

He is with the Department of Internal Medicine and Clinical Epidemiology at the Princess Alexandra Hospital.

He was speaking to Alison Caldwell and his MJA article will be published on our website shortly.