Many senior citizens are given too much medicine

21 June 2019 I Latest news

A combination of different medicines in an ageing body increases the risk of problems and adverse effects.

It is not uncommon for people aged 75 to be taking a ‘cocktail’ of prescription drugs on a daily basis, such as anti-coagulants to prevent blood clots, anti-hypertensives for high blood pressure, sleeping pills or antidepressants.

While there may often be sound reasons for concurrent use of multiple medicines, the risk of problems increases when different medicines are combined. The same applies to the risk of adverse effects. Older people are prescribed more drugs than younger people for the simple reason that, with advancing age, we are more likely to be afflicted by concomitant medical conditions, and typically conditions that require long-term treatment. At the same time, an ageing body responds differently to medicinal products. One of the problems is that many drugs are only trialled for their effects in younger individuals. This in turn means that elderly patients need regular adjustment and follow-up of their medication in order to keep consumption in check.

Three years ago, VELUX FONDEN decided to focus on the topic of ‘Senior Citizens and Medication’ as a dedicated funding scheme under its Gerontology programme. To date, just under DKK 6 million has been granted for four projects.

All four projects are being conducted in close collaboration between investigators and practitioners at hospitals, nursing homes and doctors' surgeries. 

1. One project is investigating how to reduce the incidence of urinary tract infection and the use of antibiotics in a nursing home population.
2. One project is examining successes in phasing out the use of antipsychotic medication in people with dementia.
3. One project will be devising resources for promoting user involvement and self-determination in the context of prescribing antidepressants for vulnerable elderly individuals.
4. One project is aiming to devise a model to reduce potentially unwarranted medication of the oldest and fragilest patients.

Professor and general practitioner Frans Boch Waldorff, Research Unit for General Practice, University of Southern Denmark, provides ongoing professional input to VELUX FONDEN's work in this field. He explains why ‘Senior Citizens and Medication’ is such a vital area to address.

”We know that the over-65s represent around 15% of the population, but that they are taking 40-50% of all prescription drugs. We also know that between 21% and 55% of elderly patients fail to take their medication as prescribed, perhaps through forgetfulness or confusion about dosage, adverse effects and age-related sensitivity to the medication. Around 10% of hospital admissions in the over-65s are due to inappropriate medication, meaning over-use or under-use of medicines,” he says, adding that ”It has been estimated that in American nursing homes, for every dollar spent on medication, an additional dollar is spent on treating drug-related adverse effects.

This poses problems all round: for patients, family and healthcare professionals alike. We lack knowledge and solutions for eliminating inappropriate medication of the oldest and frailest patients, which is why funding research in this area makes such good sense,” is the conclusion from Frans Boch Waldorff.

Lise Bonnevie, Head of Programme, VELUX  FONDEN, recounts her experiences of ‘Senior Citizens and Medication’: ”Many local authorities and hospitals are developing methods to improve medicinal  treatment of elderly patients, but rational use of medicines in the elderly population is a relatively new field of academic research, and we need to determine which interventions are effective, and why. It
is still an under-researched field, in spite of the immense problems in healthcare practice, both for next of kin and in the lives of older people.”

For Lise Bonnevie, engaging everyone involved is key to ensuring that the results of the research benefit senior citizens. ”With these research funds, we are hoping to see more projects in which patients and next of kin are involved on an equal footing with  nurses, physicians and other medical professionals, meaning genuine user involvement.

An additional perspective is interdisciplinarity. Partnerships between clinical investigators and local authorities, general practitioners and patients, for example, are likely to have a positive influence on project outcomes,” says Lise Bonnevie.