Simply educating older people about the importance of safe medicine taking isn’t enough to protect them against the risks of polypharmacy, a review has found.

Dr Amanda Cross

Instead, education needs to be backed up with behavioural interventions such as the use of alarms, dose administration aids and changes to medication regimens, the Cochrane Library review by Monash University researchers found.

Their review marks the first time interventions for improving medication‐taking ability in older adults prescribed multiple medications has been evaluated.

Lead researcher Dr Amanda Cross from University’s Centre for Medicine Use and Safety told Community Care Review that polypharmacy is increasing in developed nations as people live longer and become diagnosed with more medical conditions.

Behavioural interventions mixed with education can improve the proportion of people who adhere to their medicine regime.

Dr Amanda Cross

About one in three older people are taking five or more medications according to a study published in the MJA last year.

While the focus is often on de-prescribing, less is being done in terms of looking at how to make taking multiple medicines safer when it’s unavoidable.

“If you’ve got multiple conditions and polypharmacy is still unavoidable,our research was looking at the problem of how can we make sure people are taking their medicines safely,” she said.

Dr Cross says previews reviews have also looked at younger people, and interventions that work with them may not be appropriate for older people who may be experiencing functional and cognitive decline.

Comparing interventions

The review included 50 studies involving 14,200 people and grouped the interventions into three groups.

The first were education-based intervenions such as counselling on medication, medication reviews.

The second had behavioural components such as changing medication regimens, using dose administration aids, setting up alarms to remind people to take medicine.

The study found that education combined with a behavioural element was most effective in reducing emergency department and hospital admissions.

“The findings were but behavioural interventions mixed with education can improve the proportion of people who adhere to their medicine,” she said.

 “Telling people the importance of adhering may not be sufficient, we need to be able to work with people to identify what their barriers or to poor medication taking are and then address those on an individual basis.”

Carers need to ask questions like, is the problem that the regime is too complex? Is the medicines too expensive? Is an older person struggling to open a container or break a tablet?

“For both carers and health professionals it’s about taking time to understand that person identify what they’re concerns or challenges are what they’re struggling with,” Dr Cross says.

The study also highlighted a need for more an better quality research in to the area, as well as cost and clinical outcomes analysis, to inform policy making and a national approach.

Covid 19 increasing risks

Dr Cross says COVID-19 may have exacerbated the risks associate with polypharmacy for older people.

“They may not be having the same connections with health care professionals that they previously had and they might not be going in to check with their pharmacist or doctor as frequently.

“That monthly check with your pharmacist is often when you might be able to identify problems.

“And any change in routine, especially for older people, can increase the risk of missing medication, because they may link it with things like visiting a friend or going to the club.”

Dr Cross believes telehealth will play an increasing role in medication management in the future as a result of COVID-19.

“Some of our interventions involved online telehealth or mobile phone apps to remind people to take their medication, and that definitely has an emerging role post COVID-19.”

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