Geriatrician consultations on appropriate prescribing for frail older people in residential aged care facilities

This article is free to read on the publishers website Introduction: Residential aged care facilities (RACFs) in Australia have attracted considerable attention in recent times as institutions where prescribing of certain classes of high-risk drugs such as antipsychotics, potent analgesics, and sedatives is excessive and potentially inappropriate. To ensure appropriateness of therapy in RACFs, well-organized approaches are needed. We examined the patterns of prescribing, and subsequent changes made by geriatricians, in the context of comprehensive geriatric assessment consultations provided to residents of RACFs delivered by video-conference. Methods: Design: Prospective observational study. Setting: Three residential aged care facilities in Queensland, Australia. Participants: 75 residents referred by General Practitioners (GPs) for comprehensive geriatric assessment delivered by video-consultation. Results: Patients had multiple co-morbidities (mean 6), high levels of dependency and were prescribed a mean of 8.6 regular medications. Polypharmacy (≥5 medications) prevalence was over 90% with 10% (n = 70) of medications identified as potentially inappropriate according to the 2012 Beers criteria. High-risk medications (based on the list of high risk medications in older people) accounted for 26.5% (n= 183). Geriatrician intervention recommended withdrawal of 12% (n = 83) and dose alteration in 7% (n = 48) of all medications prescribed. New medication were initiated in 56% (n= 42) patients. Of those medications identified as potentially inappropriate and high-risk, only 11% (n = 28) were stopped and dose altered in 9% (n = 23). Conclusion: There was a high prevalence of potentially inappropriate and high-risk medications. However, in spite of this awareness, geriatricians made relatively few changes, suggesting either that, on balance, prescription of these medications was appropriate or, because of other factors, there was a reluctance to adjust medications. Further research, including a broader survey, is required to understand these dynamics