Increased life expectancy and a greater proportion of elderly in Sweden and other countries also lead to an increased use of medication. A new doctoral thesis from Lund University is the first study to illustrate, in a more extensive manner, the benefits of working systematically with elderly people’s medication intake already in primary care.
Despite various initiatives to reduce incorrect and unnecessary prescribing of medication for elderly people in Sweden, the total consumption among people over 75 is increasing. One way to improve the situation may be to initiate personal medication reviews and other interventions, as early as in primary and outpatient healthcare, to a greater extent than today.
“More organised prescription of medication is beneficial to our elderly and society as a whole. Previous studies show that as much as 30–40 per cent of hospital emergency cases are due to medication-related problems, and the majority of these are preventable”, says Cecilia Lenander, pharmacist at Näsets läkargrupp in Höllviken/Skanör, who recently obtained her PhD from Lund University.
The majority had more than 10 different types of medication
In her research, she has evaluated two different methods with the aim of minimising unnecessary or inappropriate medication of elderly people in primary healthcare:
Medication review in which a doctor and a nurse, together with a pharmacist, go over the various medications taken by one individual. Based on a holistic perspective, the prescriptions and intake can subsequently be adjusted accordingly.
SÄKLÄK (safe use of medication in primary healthcare) – a method in which the management at the healthcare centre makes a personal assessment of their work procedures. The method is inter-professional and also includes an external review, feedback and agreement on measures.
The research on medication reviews is based on data from approx. 1 700 such reviews in Skåne, conducted in primary healthcare and focusing on patients living in special housing. The research shows that 8 out of 10 had at least two medication-related problems. The studies also show that the average age was 87.5, that the average number of medications they had was 11.3 (between 1 and 35) and that 61 per cent of the patients took at least 10 different kinds. As a result from the reviews, the use of potentially inappropriate medications, neuroleptics and parallel use of multiple psychotropic drugs decreased to a varying extent.
Calls for better coordination of the healthcare chain
In her thesis, five healthcare centres, located in different parts of Sweden, which had tested SÄKLÄK, were compared to five others which had continued to work according to regular procedures. At the healthcare centres which had adopted SÄKLÄK, she noted a decrease of 22 per cent on average in the number of prescriptions of potentially inappropriate drugs. She also noted a decrease in the control group; however, it was lower and stayed at 9 per cent.
“The participants in SÄKLÄK were very positive about working inter-professionally, but at the same time felt that the method was too time-consuming. As a result, a new research study is now underway, in which SÄKLÄK has been adjusted and simplified”, says Cecilia Lenander.
The issue of inappropriate and excessive medication among elderly people is not new, but the problem persists. How do you believe it can be solved?
“Outdated medication lists are a national concern. My personal opinion is that all elderly people who seek primary healthcare and are in need of a medication review should get it. More coordination between different links in the healthcare chain is also necessary.”
Thesis: Cecilia Lenander defended her thesis “Interventions to improve medication use in elderly primary care patients” at Lund University on 5 May 2017.
Facts on inappropriate medication for elderly people: The Swedish National Board of Health and Welfare has created a list of drugs that have side-effects that are of high risk to people over 75. These should be used only if there are special reasons. The list includes various sleeping-pills, anti-incontinence drugs and painkillers.
Even though the healthcare sector focuses on reducing prescriptions of these listed drugs, the total intake of an average elderly person in Sweden is increasing. More multiple illnesses and the launching of new drugs may be causes. More information about elderly people and medication, as well as the list of inappropriate medication can be found at: http://www.socialstyrelsen.se/aldre/aldreshalsa/aldreochlakemedel (in Swedish)
PhD at the Department of Clinical Science in Malmö, Lund University, and pharmacist at Näsets läkargrupp in Höllviken/Skanör
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