Abstract
BackgroundHigh risk prescribing can compromise independent wellbeing and quality of life in older adults. The aims of this project are to determine the prevalence, risk factors, clinical consequences, and costs of high risk prescribing, and to assess the impact of interventions on high risk prescribing in older people.MethodsThe proposed project will utilise data from the 45 and Up Study, a large scale cohort of 267,153 men and women aged 45 and over recruited during 2006–2009 from the state of New South Wales, Australia linked to a range of administrative health datasets. High risk prescribing will be assessed using three indicators: polypharmacy (use of five or more medicines); Beers Criteria (an explicit measure of potentially inappropriate medication use); and Drug Burden Index (a pharmacologic dose-dependent measure of cumulative exposure to anticholinergic and sedative medicines). Individual risk factors from the 45 and Up Study questionnaire, and health system characteristics from health datasets that are associated with the likelihood of high risk prescribing will be identified. The main outcome measures will include hospitalisation (first admission to hospital, total days in hospital, cause-specific hospitalisation); admission to institutionalised care; all-cause mortality, and, where possible, cause-specific mortality. Economic costs to the health care system and implications of high risk prescribing will be also investigated. In addition, changes in high risk prescribing will be evaluated in relation to certain routine medicines-related interventions. The statistical analysis will be conducted using standard pharmaco-epidemiological methods including descriptive analysis, univariate and multivariate regression analysis, controlling for relevant confounding factors, using a number of different approaches.DiscussionThe availability of large-scale data is useful to identify opportunities for improving prescribing, and health in older adults. The size of the 45 and Up Study, along with linkage to health databases provides an important opportunity to investigate the relationship between high risk prescribing and adverse outcomes in a real-world population of older adults.
Highlights
High risk prescribing can compromise independent wellbeing and quality of life in older adults
In older adults, high risk prescribing can be defined as prescribing likely to lead to adverse clinical outcomes or prescribing that does not align with quality use of medicines principles
The concomitant use of multiple medicines is often indicated in the treatment and prevention of health problems, polypharmacy is generally considered as high risk prescribing in older adults, and is associated with increased risk of harm [1,2,3], including adverse drug reactions, falls, hospitalisation, institutionalisation, and mortality [1]
Summary
High risk prescribing can compromise independent wellbeing and quality of life in older adults. A range of indicators have been proposed to quantify high risk prescribing in older people These include multiple medication use or polypharmacy, potentially inappropriate prescribing and exposure to high risk medicines, measured using different risk assessment tools. The concomitant use of multiple medicines is often indicated in the treatment and prevention of health problems, polypharmacy is generally considered as high risk prescribing in older adults, and is associated with increased risk of harm [1,2,3], including adverse drug reactions, falls, hospitalisation, institutionalisation, and mortality [1]. The prevalence of “hyperpolypharmacy” (concomitant use of ≥ 10 medicines) in community-dwelling older adults has been reported to range from 5% to 26% [5,6]
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