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.
Posted by ProPortion Foods Blog on May 20, 2019 in Aging
“What matters most?” This is the theme for Australia’s National Palliative Care week from 19-25 May. It aims to encourage people to plan ahead as their life is nearing its end.
In doing so, it’s important to discuss care arrangements with loved ones and health professionals and consider what is most important.
Palliative care is family-centred support for someone who is approaching death with virtually no chance of being cured. The primary aim is to optimise quality of life, particularly in the final weeks and days.
It is “care that helps people live their life as fully and as comfortably as possible when living with a life-limiting or terminal illness,” says Palliative Care Australia. It can be given at home or in a hospital, hospice or aged care facility.
Importantly, it embraces individual needs on physical, emotional, social, cultural and spiritual levels. It also allows for the needs and bereavement of loved ones.
Services include relieving pain and other symptoms like breathing difficulties, facilitating discussions with family and friends, and providing counselling support and resources to assist care at home.
Palliative care involves a team of professionals who can cater for different needs, extending to referrals for home help, financial support and respite care services.
Health professionals might include a GP, aged care worker, cardiologist or other specialist who can provide support when symptoms become hard to manage.
Not only is palliative care the most compassionate way to support dying patients and their families, it has major cost benefits as well.
Reducing needless hospital transfers and medical interventions can help patients receive quality support, dignity and respect, while making significant cost savings, according to Australian research.
Yet, while over a third of deaths occur in aged care facilities, only a small proportion of residents are formally assessed as needing palliative care.
Talking about death tends to be taboo in our society. But we are all confronted with it at some stage. Embracing discussions about death is important to help people come to terms with their feelings about dying and how they want to deal with it.
Some groups are proactively creating opportunities for people to think and talk about death.
The organisation Portable says, “a good death is a human right, and we need to be able to articulate what this means for ourselves and communicate it outwards.” Achieving this, they advocate, will need a human-centred approach in policy and social engagement.
Death Café facilitates spaces where people can “drink tea, eat cake, and discuss death”. So far, they’ve held more than eight thousand cafes in 65 countries and provide opportunities for people to host their own.
The GroundSwell Project has created a “Dying to Know Day” on 8 August to help break the taboo and equip people “to care for themselves and each other through death, dying and loss.”
Through raising awareness and creating these discussions, grieving patients, family and friends will be freer to talk about how they feel, and people around them will be empowered to know what to do, say, or just comfortably be there for them.
Posted by ProPortion Foods Blog on May 11, 2019 in Aging
Globally, for the first time, there are more people over 65 than under five years of age. In Australia, the percentage of older people has tripled in less than a century and continues to grow.
These enduring global trends can largely be attributed to safer childbirth, fertility declines and improved medical treatments.
What implications does this “demographic time bomb” have for health and wellbeing?
In 2017, 3.8 million Australians were aged 65 years and over, according to a survey by the Australian Institute of Health and Welfare. This comprises 15% of the population, compared to just 5% in 1937.
In the global scheme of things, that puts Australia about halfway between Papua New Guinea and Japan, countries with the smallest and largest proportions of older adults, respectively.
This growth is still in steep ascent, expected to reach 8.8 million older Australians by 2057 – more than one in five people – and 12.8 million, or one in four people, by 2097.
The profile of this older cohort itself is expected to shift upwards.
Two years ago, more than half of older adults were aged 65 to 74 while 13% were aged 85 and over. In less than 30 years it’s predicted that people in the 65 to 74 age bracket will drop while 20% of people over 85 will be alive.
This trend presents several social, financial and environmental challenges. Remaining healthy is an important means by which older adults can continue to contribute to the broader community’s social, cultural and economic fabric.
While nine in ten older adults said they can confide in someone outside their household and had access to support in times of crisis, their health behaviours do not look so encouraging.
Fruit and vegetable consumption didn’t fare too well either; like the rest of the population, less than one in ten older Australians reported eating the recommended serves of these highly nutritious foods each day.
And while one in eight people in this older cohort reported being engaged in employment, education or training, more than half reported experiencing stress – the most common causes being serious illness or loss of a loved one.
Ultimately, while researchers are on the hunt for ways to reverse aging, it is possible to stay healthy and productive while growing older. The Blue Zone regions, for instance, are home to record numbers of centenarians with low rates of chronic disease.
Some lifestyle factors they share in common include daily activity, regular relaxation, eating a diet rich in plant foods, only eating until 80% full, and maintaining supportive family and social networks.
Other solutions include being involved in work. Paid work can boost income and bring psychological benefits through social and mental engagement. Many businesses are recognising the need for a balanced workforce of younger and older employees.
Unpaid work, like volunteering, care work and artistic pursuits, also brings rewards. Connecting older and younger people can yield mutual benefits. Volunteering itself can bring a sense of competence and confidence, keep people active and prevent isolation.
Posted by ProPortion Foods Blog on Mar 18, 2019 in Aging
With aging, the body’s inbuilt mechanisms for sweeping out and recycling cellular metabolic waste products starts to wane.
Kick-starting this inbuilt cleaning up process, known as “autophagy”, could be a key anti-aging target to slow the degenerative impacts of growing older.
First named in 1963 by Christian de Duve, Yoshinori Ohsumi identified autophagy mechanisms in the 1990s, earning him the 2016 Nobel Prize.
Autophagy literally refers to eating yourself (“auto” means self and “phagy” means eat).
For years it was thought to just be a form of programmed cell death. But researchers have now “shed important light on the true identity of autophagy – which is, in part, an adaptive cellular mechanism,” writes Beth Levine in the journal Cell Death and Differentiation.
By cleaning up waste products and damaged cells, autophagy stimulates cellular repair and regeneration. So rather than causing cell death, autophagy boosts cell survival.
“It is recycling and cleaning at the same time, just like hitting a reset button to your body,” Dr Luiza Petre told Healthline. “Plus, it promotes survival and adaptation as a response to various stressors and toxins accumulated in our cells.”
When cells are stressed by disease, autophagy ramps up its spring cleaning. It has therefore gained much attention for its role in several conditions including obesity, diabetes, cancer, and infection.
The process decreases with aging, which may contribute to age-related pathologies including reduced muscle mass, neurodegeneration, heart malfunction, fat accumulation and increased insulin sensitivity.
Diminished autophagy has also been implicated in Parkinson’s and Alzheimer’s disease.
Although more research is needed, Nuria Martinez-Lopez and co-authors suggest that “longevity and health-span can potentially be improved by activating [autophagy] pathways”.
The most well-established mechanism for triggering this process is caloric restriction – reduced food intake without malnutrition – and fasting, defined by Fernanda Antunes as “the complete deprivation of food but not water, with intervening periods of normal food intake”.
This can be intermittent fasting – alternate day fasting for over 16 hours or 48 hours of fasting per week – or periodic fasting (a minimum of 3 days of fasting every 2 or more weeks).
Restricted dietary intake has been shown to decrease the incidence of age-related diseases and to increase life span in many experimental models ranging from yeasts to mammals.
Autophagy might account for the benefits that caloric restriction has shown for reducing risk of diabetes, heart disease, cancer, and brain-related diseases.
There may be other ways to trigger cell cleaning and regeneration. A flowering Japanese plant called ashitaba (Angelica keiskei) has been traditionally used in Asian medicine for its longevity and health-promoting properties.
Recently, researchers discovered the plant contains a powerful flavonoid, DMC, that lengthened the lifespan of yeasts, fruit flies, worms and human cells – primarily through switching on the cells’ fasting response.
Older adults considering caloric restriction or intermittent fasting should consult their health care professional, being especially mindful of the high malnutrition risk with aging.