Study flags medication risk during aged care transition

A newly published study has identified an increased medication-related risk after patients enter aged care due to new treatments that are started in error.
 
The large retrospective Australia-based study, which was published this month in the Age and Ageing journal, looked at the medication records of 167,850 people aged 65 and older who entered long-term care facilities across the country.
 
Researchers analysed the number of prescribing cascades – defined by Australian Prescriber as when a new medicine is prescribed for an adverse reaction to another drug ‘in the mistaken belief that a new medical condition requiring treatment has developed’ – both before and after entry.
 
The study found 16.7% of people had at least one prescribing cascade before entering an aged care facility, rising to 25.1% afterwards.
 
‘Many prescribing cascades involved high-risk medications such as antipsychotics, benzodiazepines and opioids,’ the researchers wrote.
 
The work was led by the Registry of Senior Australians Research Centre at South Australian Health and Medical Research Institute and Flinders University, with lead researcher Professor Gill Caughey saying the findings highlighted an under-recognised safety issue.
 
‘Transitioning into residential aged care is one of the most vulnerable periods for older people when it comes to medication safety,’ she said.
 
‘What we’re seeing is that many residents are exposed to patterns of prescribing that may unintentionally lead to harm.’
 
Dr Anthony Marinucci, the Chair of RACGP Specific Interests Aged Care, agrees the study ‘reinforces that entry into residential aged care is a very vulnerable period for medication safety’.
 
He notes the study described potential prescribing cascade patterns.
 
‘The data shows prescribing sequence, not causation, prescribing intent or actual harm,’ he told newsGP.
 
‘The repeated involvement of antipsychotics, benzodiazepines and opioids is concerning in frail older people, given the high-risk nature of these medications.
 
‘I would also mention that some prominent associations, particularly those involving statins, may reflect multimorbidity, frailty or intercurrent illness rather than a direct prescribing cascade.’
 
Dr Marinucci notes too that overall rates identified in the study were almost identical whether or not patients were living with dementia, although there were some dementia-specific patterns which involved sleep and sedating medicines.
 
‘And higher rates after entry is not sufficient to prove residential aged care caused them,’ he said.
 
‘Changing health, frailty and closer monitoring may also contribute.’
 
He said when there is a new symptom following a medication change GPs should ‘always consider whether it may be an adverse drug effect’.
 
Dr Marinucci added that a person’s admission into an aged care home ‘should trigger medication reconciliation and timely, coordinated review involving the GP and pharmacist, with deprescribing where appropriate’.
 
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