Risks and side-effects of medication therapy
Elderly people often need to take a lot of different medications as they suffer from a range of ailments. Studies have showed that they frequently receive too many medications, or not enough of them, or the wrong ones. The contribution that pharmacists can make to improve medication therapy for residents of old people's homes and nursing homes is currently being investigated by the Clinical Pharmacy Working Group at Münster University (WWU). The aim is to reduce medication-related problems and lower the costs of medication through improved therapy. Seven old people's homes and nursing homes in Münster are taking part in the study. The residents' average age is 81.
"A third of people over the age of 70 suffer from at least five chronic illnesses," says Julia Kruse, a pharmacist, with reference to a study carried out in Berlin. Kruse is conducting the Münster study – led by Dr. Georg Hempel, a professor at WWU – as part of her PhD thesis. "This so-called multi-morbidity is treated with a range of different medications which are not always compatible with each other. Symptoms of a new side-effect are often misdiagnosed as being a new illness, and so an additional medication is prescribed. These so-called prescription cascades increase the risk of hospitalization through unwanted effects resulting from the medication." Also, the metabolism changes with age, with the result that the doses of medications administered often have to be adjusted. "There are a number of medications which elderly people can longer take. Recently the so-called Priscus List was published, giving details of such medications. Many of these make elderly people confused or tired, thus increasing the risks of falls."
The research is being carried out as an intervention study. This means that during the study intervention takes place on the part of the researchers. In this case it is a question of making recommendations for improving medication therapy. Julia Kruse looks at the situation before and after any intervention.
In the first phase of the project, which has now been completed, Kruse started by collecting data on the current situation. An average of 8.1 illnesses were diagnosed for the residents of the homes taking part in the study. Each resident is being treated by 2.4 doctors and takes 8.4 different medications. "Many doctors don't know what their colleagues are prescribing," says Kruse, "and this can often lead to interactions between the various medications. The risk increases with the number of doctors treating each resident."
Julia Kruse is now looking to see which residents are taking unsuitable medications, and whether any problems such as reciprocal effects or false dosages occur. The findings from interviews with nursing staff will also be incorporated in the research. "It is here that information can be gathered on additional problems which occur in administering medications but which are not noticed just from reading files," she explains. "Often, for example, tablets have to be crushed because otherwise residents have difficulties in swallowing them. However, this cannot be done with all medications, and this is often ignored when they are prescribed."
Opportunities have been found for nearly all of the residents examined so far to improve their medication therapy. Julia Kruse sends appropriate suggestions to the prescribing doctors, who then have a chance to look at the problem and, if necessary, discuss the case with her as a pharmacist. About eight to twelve weeks after the intervention Kruse checks to see if the patients' medication therapy and condition have changed.
In the Münster project, which is being funded by the Westphalia-Lippe Pharmacists Foundation (Apothekerstiftung Westfalen-Lippe) and the Funding Initiative for Pharmaceutical Care (Förderinitiative Pharmazeutische Betreuung e.V.), a total of 374 residents in seven old people's homes and nursing homes are being supervised. All have agreed to take part in the project. Further funding by the Ministry of Labour, Health and Social Affairs in the state of North Rhine-Westphalia has made it possible to recruit an additional pharmacist to look after another 196 residents of old people's homes and nursing homes in a similar way in the Hamm, Wesel and Soest areas.