6.1 Polypharmacy, 75 years and over

Polypharmacy is when people are using five or more medicines at the same time. It is common in older people because they often have several chronic conditions that need multiple medicines.

About two-thirds of Australians aged 75 years and over take five or more medicines. This includes over-the-counter and complementary medicines.

Polypharmacy can have risks of medicines-related harm, especially for older people.

In 2018–19:

• 690,516 people aged 75 years and over were dispensed five or more medicines under the Pharmaceutical Benefits Scheme (PBS), representing 40,226 people per 100,000 people aged 75 years and over (the Australian rate)
• The number of people who were dispensed five or more medicines across 328 local areas ranged from 11,206 to 72,059 per 100,000 people aged 75 years and over
• The rate was 6.4 times as high in the area with the highest rate compared with the area with the lowest rate
• Rates were higher in major cities and inner regional areas than in outer regional areas or remote areas
• Rates were higher in areas of socioeconomic disadvantage, except in remote areas
• 49% of people with polypharmacy had seven or more medicines dispensed, and 8% had 11 or more medicines dispensed.

Rates are standardised to remove age and sex differences between populations.

The Atlas examined polypharmacy using prescription dispensing data from the PBS. It is likely to under-estimate the extent of polypharmacy in Australia because over-the-counter and complementary medicines are not counted.

Variation in rates of polypharmacy is likely to be due to differences in:

• Patient need – areas with higher rates of chronic disease are likely to have more people with polypharmacy
• Patient care – the more clinicians a person goes to, the less likely that one clinician will have oversight over all their medicines
• Number of aged care homes – people living in aged care homes are more likely to take multiple medicines than people living in their own home. Therefore, areas with more aged care homes are likely to have higher rates of polypharmacy.
• Clinical decision-making – many guidelines do not take into account prescribing for older people with multiple conditions
• Access to clinicians – the number of clinicians providing services in an area can influence how often people seek care. Clinicians’ prescribing practices can also vary.

• Encourage use of medication management reviews to minimise the risk of medicines-related harm (see 6.2 Medication management reviews).
• Encourage consumers and clinicians to discuss the risks and benefits of medicines.
• Help older people keep an up-to-date medicines list.
• Encourage GPs and pharmacists to routinely ask consumers about over-the-counter and complementary medicines they might be taking.
• Ensure that people’s medicines are accurately recorded when they move between care settings.
• Develop evidence-based guidelines that take into account people with multiple chronic conditions.
• Remove barriers to deprescribing, and include information about deprescribing in medicines product information.
• Monitor rates of polypharmacy as a quality indicator in hospitals.
• Promote initiatives such as the EVOLVE program to minimise harms from polypharmacy.

The Commission consulted widely, but is solely responsible for making the recommendations; as such, the recommendations may not reflect the views of all contributors to the Atlas.

6a. The Commission, in collaboration with the Australian Government Department of Health, the Aged Care Quality and Safety Commission, NPS MedicineWise and relevant groups, to develop nationally consistent:

• i. Guidance for people taking multiple medicines
• ii. Guidance about the communication of reports to medical practitioners from Residential Medication Management Reviews and Home Medicines Reviews
• iii. Measures for aged care homes to compare the percentage of residents who have received Residential Medication Management Reviews and the percentage of pharmacists’ recommendations, in line with the Commonwealth’s development of the National Aged Care Mandatory Quality Indicator Program
• iv. Guidance for the establishment, governance, composition and operation of Medication Advisory Committees within aged care homes.

6b. The Australian Government Department of Health to investigate ways of collecting patient-level data on the supply of PBS medicines through the S100 Remote Area Aboriginal Health Services Program to gather accurate information about the use of medicines in rural and remote Aboriginal communities.

Download the Polypharmacy, 75 years and over section of the Atlas below, to read more about the context, data, key findings, interpretation, and addressing of variation for this clinical item:

Contents:

• Context
  • Why examine polypharmacy in people aged 75 years and over?
  • Rates of polypharmacy in older people in Australia
• About the data
• What do the data show?
  • Magnitude of variation
  • Analysis by remoteness and socioeconomic status
  • Analysis by number of medicines for people with polypharmacy
• Interpretation
  • Possible reasons for variation in rates of polypharmacy
• Promoting appropriate care
  • Medication management review
  • Shared decision making
  • Medicines lists
  • Lifestyle factors
  • Medication reconciliation at transitions of care
  • Guidelines adaptation and comorbidities
  • Deprescribing
  • Active ingredient prescribing
  • Electronic decision support tools
  • Monitoring of polypharmacy 
  • Promoting existing initiatives
• Resources
• Australian initiatives
• References