Nearly one million Australians over 70 are taking five or more medicines every day, and this number is continuing to grow, researchers from the Universities of Western Australia and New South Wales have revealed in the Medical Journal of Australia.
Using multiple drugs together, especially five or more, can produce several adverse outcomes including side effects, dysphagia, nutritional deficiencies, impaired cognition, falls, hospital admissions and mortality.
In fact, the World Health Organisation has set a target to halve polypharmacy and other unsafe prescription practices as part of its third global patient safety challenge to reduce medication-related harm.
Older adults tend to have several chronic conditions and often take different drugs to reduce the symptoms and risk of complications. People with higher needs, hospital inpatients and aged care residents tend to take the most meds.
Drawing from a nationally representative sample of people eligible for PBS-listed drugs between 2006 and 2017, Dr Amy Page and co-authors found that the prevalence of polypharmacy grew by nine percent.
And because of population growth, there was a 52 percent increase in the number of people taking five or more medicines a day over that period. In community care, the number of older adults receiving medications has grown rapidly, doubling over the past 20 years.
The researchers say these estimates may be conservative, because they don’t factor in medicines and supplements obtained without a prescription.
Some medicines stopped being subsidised and would also have not been recorded; this may account for the fact that medication use started to decline again after 2016 – although it was close to one million in 2017.
It must also be noted that some drugs are being combined to reduce pill burden, and this should be factored into future investigations.
The researchers report that Australia’s polypharmacy rates are higher than the US or the UK and have been for some time.
While some medications may be necessary for older adults, there is widespread concern about inappropriate polypharmacy and its detrimental outcomes.
Professor Sarah Hilmer from the University of Sydney is one advocate for “deprescribing” unnecessary drugs – noting that some are used as preventative measures and are not even addressing an existing condition.
Sometimes people continue taking drugs into old age when they no longer need them. “Compounding this,” says Hilmer, “is the issue of the prescribing cascade – doctors prescribing a drug to treat the effects of another drug to treat the effects of another drug, without realising they are doing so.”
Her team is working on written resources for consumers as well as doctors.
Dr Page agrees, saying that strategies to improve people’s awareness about the potential risks in taking several medications should target both the public and health professionals.
One in three hospitalised adults in the US is at risk for malnutrition, a major analysis has found. And patients’ poor food intake is having a significant impact on their healing and recovery, compounding their risk of death.
“Nutrition is easily overlooked as healthcare professionals often focus on a patient’s primary diagnosis,” lead author Abby Sauer told NutritionInsight.
“It may come as a surprise to some that when patients don’t get proper nutrition, it can significantly put their health and lives at risk,” she adds, explaining that nutrition is more important than ever when someone is sick or injured.
The researchers screened around 10,000 patients from 2009 to 2015 to assess malnutrition risk and links with mortality.
They found around one in two patients were eating half or less of their meals. This low food intake was linked to higher risk of mortality, and those who ate none of their food had a nearly six-fold higher risk of dying than those who ate at least some.
The findings support previous studies that have identified hospital malnutrition as a global public health problem, including Australian research which also found that this “silent epidemic” affects one in three hospitalised patients.
Despite this growing awareness, it is still not given the attention it deserves.
“Malnutrition can be invisible to the eye and is rampant in US hospitals because it’s not always top of mind,” said Gail Gerwitz, president of nutritionDay, an organisation which was involved in the study.
Loss of muscle mass and strength takes the brunt of poor nutrition, leading to sarcopenia, an age-related disease of accelerated muscle wasting that results in a downward spiral of poor health and mortality.
Some Australian hospitals are taking action by implementing basic malnutrition and sarcopenia screening tools. Relatives can also look for key signs of malnutrition.
These include unexpected weight loss, tiredness, low mood, poor appetite, unhealthy teeth and gums, listless hair and brittle nails, constipation and poor wound healing.
Hospitals and aged care facilities can take several measures to boost patients’ food intake, by using patient-centred service models, introducing mandatory nutrition standards, addressing obstacles to eating like poor dentition, and providing a choice of meals that are tasty and appealing.
High protein, high energy meals are the first line of defence to prevent or address malnutrition and promote healing. This can be achieved by adding extra cream or butter to food. Where necessary – especially with poor appetite – supplements can be used between meals to boost protein and calorie intake.
Many older adults don’t eat enough to meet their nutritional needs, and this can impact their healing and recovery from injury.
In support of this, a 2-year pilot study has shown that giving one extra meal a day to older adults who were hospitalised with hip fractures halved their risk of dying.
The study, conducted by the NHS in the UK, was instigated after staff noticed that patients with hip fractures struggled to get enough nutrients. In the program, nutrition advisors across six sites brought food from the hospital’s canteen and sat with patients as they ate their extra meal.
As a result, mortality rates fell from 11 to 5.5 percent, and medical authorities are considering whether it should be introduced countrywide.
Often, busy staff overlook patients’ food intake, noted chief orthopaedic surgeon Dominic Inman. Commenting on the findings to The Telegraph, he said, “If you look upon food as a very, very cheap drug, that’s extremely powerful.”
Hip fractures are the most common, and most serious type of fracture in Australia, with new fractures resulting in 50,900 hospitalisations and 579,000 bed days throughout 2015-16.
The health of adults over 50 often rapidly declines after a hip fracture, exacerbating poor outcomes. For three months after fracturing a hip, older adults are at five to eight times greater risk of dying, and one in three adults over 50 dies within 12 months.
Aside from that, a hip fracture can sorely impact mobility, independence and quality of life, and many patients are transferred to another facility for ongoing care.
Falls can be prevented by maintaining good muscle mass and strength. Failing that, patient outcomes after a fall can be improved with rehabilitation aimed at getting them moving as soon as possible, and with good nutrition.
Malnutrition, although widespread, is often overlooked, so it is important to be aware of the signs.
Addressing this, Queensland researchers have tested a patient-centred food service model in a public hospital setting and showed that it increased patients’ energy and protein intake – key requirements for healing and preventing malnourishment.
The model has been used in private acute care settings for 15 years. It revolves around providing room service to patients on demand – so they get to choose what they eat and when. (Who wants dinner at 5pm if you’re not ready for it?)
This food revolution was led by Sally McCray, who says, “This innovate model demonstrates the importance of patients being able to order flexibly, both in terms of the type of food items that patients feel like eating, as well as ordering food at a time of day that they feel like eating.”
The researchers showed that, not only can it improve nutrition intake, it also results in happier patients and reduced food waste.
Posted by ProPortion Foods Blog on Nov 1, 2018 in Aged Care
In 2017 Nikki took her mini foxie Daphne for regular visits to Bupa Aged Care. They were “pet therapy” volunteers.
Every week, Nikki would have to reintroduce herself and Daphne as many of the residents didn’t remember who they were.
But after a few months some residents started recognising them…well not so much Nikki – they would remember Daphne.
Residents would join them in the living room for cuddles, pats and doggy licks. Or if they preferred to stay in their rooms, Nikki and Daphne would pay them individual visits.
Lucy was a huge dog lover with dog stuffed toys and ornaments in her room. She would always thank Nikki for remembering to visit her.
Many residents would share stories about their dogs and cats, usually from childhood.
One resident didn’t know that it was her birthday the next day. But seeing Daphne reminded her all about her beloved childhood dog – a mini foxie called Kimmy – and how her dad taught Kimmy to do tricks like sit up and shake hands.
Another lady who was confined to bed asked if Daphne could sit on her lap. “Daphne curled up and the lady started crying tears of joy because she just loves dogs so much and missed her dogs,” said Nikki.
“The pure gratitude and love that I witnessed between Daphne and the residents brought me to tears a few times,” she says. “I can’t even put it into words how it made me feel, it was just so special for everyone involved.”
Pets can boost emotional and physical wellbeing. As well as being social catalysts, they offer social support and unconditional love, reducing loneliness and feelings of isolation.
Owning pets has been linked to lower risk factors for heart disease, like reduced blood pressure. Pets can reduce stress levels, and cancer patients have reported that their pets helped them during treatment.
They can also make people laugh, says Janette Young, pet researcher at the University of South Australia, which has known health benefits. “You can’t be depressed when you’re laughing.”
Furry companions can help older adults make the transition to aged care. “We know that people’s depression increases when they go into care, because there’s all these losses,” says Young.
As well as providing comfort, pets can give people “a reason to wake up in the morning,” Young says. The sense of purpose, “that something in the world would miss you,” she adds, “that’s actually protective.”
In interviews with older adults, Young surprisingly uncovered a strong theme of suicide prevention, with people suggesting that without their pets, “they wouldn’t be here”.
“Not taking pets seriously in how we consider and support ageing means we may be condemning some older people to isolation and loneliness,” Young wrote for The Conversation.
She argues that we need to find ways to support older adults to keep their pets when they go into full time care.
Some aged care centres – like Bupa – are welcoming pets because of their demonstrated health benefits. Weighing up the challenges, evidence suggests that the benefits are well and truly worthwhile.
Perhaps pet therapy should be included in new standards for aged care?
Young points out, though, that it’s important to consider the pets’ welfare. Research shows that dogs can be stressed, for instance, but people are unaware of the signs – like looking away, lip licking and yawning.
Some breeds are more anxiety-prone than others. “So we just need to be conscious of the animals as well.”