Medicines Regimens Charted for Older People Living in Residential Aged Care: A Repeated Cross-Sectional Study Describing the Number of Medicines, Regimen Complexity, High-Risk Prescribing, and Potential Underprescribing

Amy Theresa Page; Kathleen Potter; Georgie Lee; Hend Almutairi; Kenneth Lee; Kate Wang; Nagham Ailabouni; Christopher Etherton-Beer

doi:10.1016/j.jamda.2024.01.013

Medicines Regimens Charted for Older People Living in Residential Aged Care: A Repeated Cross-Sectional Study Describing the Number of Medicines, Regimen Complexity, High-Risk Prescribing, and Potential Underprescribing

J Am Med Dir Assoc. 2024 Feb 28:104944. doi: 10.1016/j.jamda.2024.01.013. Online ahead of print.

Authors

Amy Theresa Page¹, Kathleen Potter², Georgie Lee³, Hend Almutairi³, Kenneth Lee³, Kate Wang⁴, Nagham Ailabouni⁵, Christopher Etherton-Beer⁶

Affiliations

¹ School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia. Electronic address: amy.page@uwa.edu.au.
² Ryman Healthcare, Christchurch, Canterbury, New Zealand.
³ School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia.
⁴ School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia; School of Health and Biomedical Sciences, RMIT, Melbourne, Australia.
⁵ PACE, School of Pharmacy, Health and Behavioural Sciences Faculty, University of Queensland.
⁶ WA Centre for Health and Ageing, University of Western Australia, Perth, Western Australia, Australia; Department of Geriatric Medicine, Royal Perth Hospital, Perth, Australia.

PMID: 38428832
DOI: 10.1016/j.jamda.2024.01.013

Abstract

Objective: We aimed to explore medicines regimens charted for older people living in residential aged care facilities (RACFs).

Design: Repeated cross-sectional study using routinely collected data sampled in a cross-sectional manner at 11 time points (day of admission, then at 1, 3, 7, 14, and 30 days, and 3, 6, 12, 18, and 24 months post admission).

Setting and participants: The cohort is set in 34 RACFs managed by a single Australasian provider. People aged ≥65 years admitted to permanent care between January 1, 2017, and October 1, 2021, with medicines charted on the date of admission.

Methods: Medicines charted were evaluated for potentially suboptimal prescribing including number of medicines, high-risk prescribing (eg, potentially inappropriate medicines, anticholinergic burden), and potential underprescribing.

Results: The 3802 residents in the final cohort had a mean age of 84.9 ± 7.2 years at admission. At least 1 example of suboptimal prescribing was identified in 3479 (92%) residents at admission increasing to 1410 (97%) at 24 months. The number of medicines charted for each resident increased over time from 6.0 ± 3.8 regular and 2.8 ± 2.7 as required medicines at admission to 8.9 ± 4.1 regular and 8.1 ± 3.7 as required medicines at 24 months. Anticholinergic drug burden increased from 1.6 ± 2.4 at admission to 3.0 ± 2.8 at 24 months. Half the residents (2173; 57%) used at least 1 potentially inappropriate medicine at admission, which rose to nearly three-quarters (1060; 73%) at 24 months admission.

Conclusion and implications: The total number of medicines charted for older adults living in RACFs increases with length of stay, with charted as required medicines nearly tripling. Effective interventions to optimize medicines use in this vulnerable population are required.

Keywords: Anticholinergics; Polypharmacy; high risk prescribing; potentially inappropriate medicines; residential aged care.