Multiple medication risk for older persons

A triple whammy risk to older Australians is occurring in aged care when oral non-steroidal anti-inflammatory (NSAID) medication is taken along with loop diuretics and hypertension medication.


Taking these three medications together can cause kidney failure in older people but existing medication management systems in residential aged care are not designed to red flag this occurrence.


New research from the Australian Institute of Health Innovation at Macquarie University shows that in Australian residential aged care facilities, one in 10 residents were using an oral NSAID; of those, half used oral NSAIDs long term and one in six used the triple whammy combination.


Oral NSAIDs includes ibuprofen, naproxen, diclofenac and celecoxib and are used for the management of pain such as arthritis or migraine. Many of these medications can be obtained without prescription and can pose gastrointestinal, cardiovascular, stroke, kidney, central nervous systems and fracture risks if taken longer than recommended or with other medications.


This Australia first research provides the first snapshot of NSAID use in residential aged care facilities where people are at higher risk of side effects due to their age and range of other existing health conditions such as heart or kidney disease.


The study examined the medication administration records from 68 residential aged care facilities in NSW and ACT during 2014-2017, and included 10,367 residents.


Choosing Wisely Australia states that non-steroidal anti-inflammatory drug use by older Australians be short term and reassessed regularly. For people with heart disease or high blood pressure, use should be further limited.


Lead author Dr Kim Lind, Research Fellow at the Australian Institute of Health Innovation, Macquarie University, stated that without the use of electronic medication management systems in the aged care sector, improvement in the management of this drug use is unlikely:

"We need to find a way for the prescribing doctor, the facility staff, the resident and their family to be able to clearly see what medication is being used, for how long and when it needs to be reviewed; plus other information about the resident’s health and mental wellbeing so that decisions about care can be made appropriately" said Dr Lind.”

The research is published in Pharmacoepidemiology & Drug Safety. and received nation-wide media coverage including the Sydney Morning Herald and ABC Radio.


5 September 2019.