Nearly all older Australians in residential aged care facilities are at risk of ‘suboptimal prescribing’ of medicines, including under-prescribing, over-prescribing and high-risk prescribing, according to a new study from The University of Western Australia.

"The findings indicate that many people in aged care are at risk from medicines-related harm and that the prevalence and magnitude of the use of multiple medicines look to have increased in the past decade."

Dr Amy Page, WA Centre for Health and Ageing at UWA

Professor Christopher Etherton-Beer and Dr Amy Page, from the WA Centre for Health and Ageing at UWA, led research published in Archives of Gerontology and Geriatrics on Polypharmacy and medicine regimens in older adults in residential aged care.

The review, which examined the prevalence of suboptimal prescribing, comes in the wake of the Royal Commission into Aged Care Quality and Safety 2021 which found that quality use of medicines and medicine safety was important for the wellbeing of Australians in aged care. 

“In our study, which used data from across 17 Australian aged care facilities from residents who were 65 years or older, we found that suboptimal prescribing affected 302 of 303 residents,” Dr Page said.

“Older people with multiple chronic conditions have potential to benefit from quality use of medicines but are at high risk of experiencing medicine related harm if prescribing is suboptimal.

“There are times when taking multiple medicines may be unsafe and the number of medicines, or the combination of medicines used, may increase the risk of poor health outcomes.”

The research found that most residents (92 per cent) were exposed to polyphamarcy, the use of multiple medicines, and were prescribed an average of between 14 and 15 medicines a day and at least one instance of potential under-prescribing was identified in 86 per cent of residents.

At least one instance of high-risk prescribing was identified in 81 per cent of residents and most participants (85 per cent) had highly complex regimens.

“The findings indicate that many people in aged care are at risk from medicines-related harm and that the prevalence and magnitude of the use of multiple medicines look to have increased in the past decade,” Dr Page said.

“Our research also reveals the significant burden that the complexity of medicines is placing on not only residents at aged care facilities but also staff.”

Medicine safety became a policy priority in many countries when the World Health Organisation launched its Medication Without Harm initiative in 2017, which aimed to reduce medicine-related harm by 50 per cent within five years. 

In Australia, the quality use of medicine and medicine safety became the newest National Health Priority Area.