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Older Aussies must choose medicines wisely

AAP logoAAP 12/08/2016 Sarah Wiedersehn

Doctors are being warned against the inappropriate use of medicines among older Australians, in order to prevent a harmful "prescribing cascade".

The Royal Australasian College of Physicians (RACP) as part of the Choosing Wisely Australia initiative has released recommendations on the appropriate use of medical drugs.

Older Australians may not be aware they are on a prescribing cascade, where they take one medicine and have an adverse reaction, so are put on another medicine, says the RACP.

A common example is when a patient is prescribed a non-steroidal drug for pain and then prescribed a proton pump inhibitor (PPI) to reduce the risk of stomach side effects caused by the first prescribed medicine.

Among 98 recommendations is advice against using antipsychotics as the first choice of treatment for behavioural and psychological symptoms in dementia patients.

"The use of antipsychotics is of dubious benefit and can lead to serious side effects that can be life-threatening," said RACP President Dr Catherine Yelland.

"We recommend trying non-drug interventions first as they are an effective option. Ensuring a workforce is trained to be able to deliver non-pharmacological interventions is critical to being able to provide high quality care."

Dr Yelland says care principles need to reflect the latest evidence and science, so unnecessary tests, treatments and procedures are avoided.

It's hoped the adoption of the recommendations by health professionals will improve care of elderly Australians.

"It's always timely to check with your doctor or pharmacist to see if any medicines are unnecessary and if they could cause harm if taken together," said Dr Lynn Weekes, CEO of NPS MedicineWise.

APPROPRIATE USE AND PRESCRIBING OF MEDICINE:

* reducing the use of multiple medicines

* not prescribing medicines without conducting a drug review to avoid adverse outcomes for people on 5 to 20 medications

* stopping medicines when no further benefit will be achieved, particularly for older patients with a limited life expectancy where treatments are unlikely to prevent disease

* not using antipsychotics as the first choice to treat behavioural and psychological symptoms of dementia

* not prescribing benzodiazepines or other sedative-hypnotics as first choice for insomnia, agitation or delirium

* not prescribing antibiotics for asymptomatic bacteriuria in older adults

* not prescribing medication without conducting a drug regimen review

* not using physical restraints to manage older adults with delirium.

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