Medication Use by Older People

The following extract is from one of 8 commissioned papers prepared for: 2020 A Vision for Aged Care in Australia - The Myer Foundation

Appropriate medications can significantly enhance the quality of life of older people. However, a number of preparations are considered to be inappropriate for older people, due to age-related changes in pharmacokinetics and dynamics. Further, the risk of adverse medication effects and drug interactions, and non-compliance increases with the number of medications taken.The prevalence of adverse medication effects is difficult to estimate, since not all adverse reactions are correctly identified or reported. Estimates vary from 1.5% to 50%. The chance of an older person having an adverse reaction increases from 10%, if one drug is taken, to 75% if five or more medications are used. Such adverse reactions are estimated to account for up to 22% of hospital admissions, 35% of unplanned readmissions, and almost half of nursing home admissions."

What are "Benzodiazepines" and "Psychotropic" Drugs?

Benzodiazepines are psychotropic drugs - drugs that affect the mind and are mood altering. They are commonly known as minor tranquillisers and are prescribed mainly for anxiety and sleeping problems. In the past benzodiazepines were thought to be harmless and non-addictive. However, many studies have reported that they are actually drugs of dependence and potentially lethal when taken in overdose quantities.

Psychotropic drugs (anxiolytics, antidepressants, and neuroleptics) are commonly administered to long-term care residents with dementia. Their use, however, is controversial, given that this category of drugs can be used as a form of chemical restraint. The risk that a resident will be subjected to such a restraint depends to some extent on his or her behaviour, as well as on the policy governing the use of such drugs of the facility in which they reside. However, there are some reports that question the appropriateness of administering this drug (see articles below).

The line between legitimate medicinal use of a drug and its use as a chemical restraint may be influenced by the availability of adequate numbers of appropriately trained staff. The end result may be a shifting of the line, inadvertent or otherwise, from legitimate medical use to chemical restraint use. In the context of chronic under-funding of the health care system in general, and an increase in frailty and severity of dementia of the long-term institutionalized population, the question is a pressing one.

The syndrome of falls is a common and an often serious problem in elderly people. The cause of falls is multifactorial, and medication use can be a significant contributor. The observational nature of the research in this field makes it difficult to draw conclusions regarding medication use and falls in clinical practice, although psychotropic drugs appear to be most strongly associated with falls. Medication assessment is an important part of evaluating elderly patients at risk for falling.

Some of the articles below examine the relationship between negative behavioural manifestations commonly observed amongst aged care residents and psychotropic drug administration, and seeks to determine whether staffing levels influence this relationship.