Medication Management

Optimising the quality use of medicines for people with cognitive and related functional decline

Sarah Hilmer
Simon Bell

Lead Investigators: Professor Sarah Hilmer and Associate Professor Simon Bell

Cognitive and associated physical decline influence the use, effectiveness and safety of medicines. Older people with cognitive and related functional decline often have multiple medical problems (multi-morbidity) for which they are prescribed many medicines (polypharmacy). These medicines have been evaluated to prevent and treat disease, but their ability to preserve functional independence is generally unknown.

Furthermore, effectiveness of medicines in people with multi-morbidity, polypharmacy and functional impairment is unknown. In contrast, there is growing understanding of the adverse effects of medicines in older people with cognitive and related functional decline. Adverse effects range from simple effects (e.g. bleeding) to more complex presentations (falls, confusion, functional impairment). Adverse events are often the result of exposure to several interacting medicines in vulnerable patients. While medicines can often be stopped safely, this can be challenging in routine practice. This research project seeks to answer: How can health and aged care providers reduce the drug burden on older people with cognitive decline in hospital, community and residential aged care settings?

This five-year project will synthesise existing research to identify medicines that impact on functional decline in older people with cognitive decline in different settings. During the initial stage, this project will identify relevant optimal quality use of medicines (QUM) tool or tools to guide medication selection. It will then assess factors that impede and facilitate QUM for people with cognitive decline in hospital, community and residential aged care settings, before addressing those barriers using the expertise of the Health economics, Technology and telehealth, Policy and legislation and Management of change and workforce enabling sub-units. A trial of the QUM tool(s) will then be conducted among people with cognitive and related functional decline in hospital, community and residential aged care settings with input from the partner organisations. The Technology and telehealth enabling sub-unit will facilitate application to regional and rural locations.

The trial implementations will be evaluated and plans developed for further rollouts of the QUM tool(s) and policy for older people with cognitive decline. The impact of the project will be that aged care and health organisations will have tools and implementation strategies for improving medicine management practices for older people with cognitive decline.

Focus on the implementation of the use of Vitamin D supplements in Australian Residential Aged Care Facilities (RACFs)

Ian Cameron

Lead Investigator: Professor Ian Cameron

Most people living in residential aged care facilities don’t have enough Vitamin D. As a result they are at higher risk of falls and fall related injury. Vitamin D deficiency might also have other health effects. A program in New Zealand has shown that it is possible to provide people living in residential aged care facilities with monthly doses of Vitamin D to reverse the deficiency.

This project is applying this strategy to the Australian aged care context in about 40 Australian residential aged care facilities. The research team anticipates that there will be a number of potential barriers to be overcome, such as acceptance of the recommendation for vitamin D supplement use by some general practitioners, facility staff, residents and family members. Implementation will be facilitated largely by providing information and education in a variety of formats to multiple stakeholder groups. Following this, locally identified strategies will be implemented at each site to help enhance and sustain the implementation of vitamin D supplement use.

Telehealth enabled systems to improve medicines use among persons with cognitive impairment and dementia in residential aged care facilities

Ruth Hubbard
Simon Bell
Sarah Hilmer
Len Gray

Lead Investigators: Professor Len Gray, Professor Sarah Hilmer and Associate Professor Simon Bell

There is substantial evidence that medicines use among people with dementia who are living in aged care facilities is not ideal. However, ideal prescribing requires a difficult balance between under- and over-prescribing. Those responsible for prescribing, dispensing and administering medicines can be assisted through prescribing guides; and through reviews conducted by specialists, namely Geriatricians and Pharmacists. However, because visits by specialists are infrequent and expensive, reviews do not occur consistently, nor do they occur simultaneously among General Practitioners (GPs), Geriatricians and Pharmacists.

Telemedicine provides opportunities to overcome these difficulties. We propose a series of development and research projects to develop and test telehealth strategies to tackle this problem. These include:
1. An electronic assessment system to alert practitioners to medication profiles that suggest a need for closer scrutiny
2. An online system to enable specialists to review and recommend changes to medicines without visiting a facility, including an ability for GPs, Pharmacists and Geriatricians to share opinions online
3. A method to build on the online system to support Geriatrician consultation, including medication review, via video-conference
4. A trial to examine if telehealth enabled medication review conducted by a geriatrician can improve prescribing appropriateness

These systems, if successful, would improve the timeliness and efficiency of medication review. In practice, this means specialist medication review is available for more people more promptly, including those in rural and remote communities. In turn, more appropriate prescribing among people with dementia will result in fewer symptoms and side effects. We believe that individuals with dementia in Residential Aged Care Facilities (RACFs) are exposed to the greatest risk of sub-optimal medication use, and stand to benefit most from an improved approach.