Research review delves deeper into medicine prescribing for adult populations
Community and Oral Health Senior Pharmacist Mr Jalpesh Triedi and Senior Medical Officer Dr Gloria Wong are revealing opportunities to better support the management of patient’s use of multiple medications.
An in-depth research review has uncovered some revealing opportunities to better support the management of patient’s use of multiple medications, particularly younger adults.
Community and Oral Health General Medicine Senior Medical Officer Dr Gloria Wong said polypharmacy – prescribing five or more medications – was often associated with older patients, with little known around the trends, risks and impacts on younger adults.
“Polypharmacy is a significant and expanding public health concern which affects all healthcare settings, and its prevalence is increasing globally. Younger adults are a population that is frequently overlooked in research in this area,” Dr Wong said.
“In Australia, 20.9 percent of people have polypharmacy and 3.3 percent have super-polypharmacy (10-plus medications).
“The proportion of the population who are prescribed multiple medications increases with age among individuals aged 20 to 39 years (2.56%) versus individuals aged 40 to 64 years (15%).
“Although the number affected is smaller for adults compared to people over 65 (38.6%), it is still quite substantial.”
In collaboration with senior pharmacist Mr Jalpesh Triedi, Dr Wong conducted a scoping review to identify the characteristics, risks and deprescribing frameworks that exist for this under researched population, adults up to 65 years of age.
“While several validated tools exist for geriatric adult populations, there are currently no deprescribing tools for non-geriatric adults, representing a clear gap in clinical practice and research,” Dr Wong said.
“The core principles of deprescribing such as evaluating appropriateness, considering patient values and preferences, and applying collaborative multidisciplinary models are likely relevant to younger adults, but further research is needed to determine effectiveness.
“We hope this initial work will lead to the development of evidence-based, age-appropriate guidelines and validated tools which will enable healthcare providers to improve medication management.”
Polypharmacy is common in frail individuals with multiple comorbidities and underlying social, physical and psychological determinants.
It is linked with adverse health outcomes, including cognitive impairment, frailty, falls, reduced physical functioning, adverse medication effects, higher rates of readmission and hospitalisation, mortality and decreased medication efficacy.
“Frailty can also affect younger adults, particularly those with chronic disease, multimorbidity or disadvantage, making its identification equally important across the adult age spectrum,” Dr Wong said.
Most studies identified the need for effective intervention via multidisciplinary teams to identify inappropriate medications, and addressing polypharmacy requires a multifaceted approach that includes deprescribing as a pivotal intervention.
“Primary care settings, including GPs and primary healthcare teams, play a pivotal role in addressing polypharmacy and implementing successful interventions,” Dr Wong said.
Dr Wong said the next step was to take a deeper dive into the local data to identify actionable changes that may improve patient outcomes, and co-design with patient tools and strategy to manage polypharmacy.
Polypharmacy and super-polypharmacy in non-geriatric, adult populations: a scoping review of characteristics, risks, and deprescribing frameworks is published in the Journal of Pharmacy Practice and Research.