Medical School

Postgraduate research profiles

Contact

Amy Page

Phone: (+61 3) 9016 9752


Start date

Sep 2012

Submission date

Sep 2017

Amy Page

Amy Page profile photo

Thesis

Too much of a good thing? Deprescribing medicines in older adults

Summary

My research aims to understand which medicines to use for older people, particularly those with dementia, to ensure the longest possible good quality of life. This PhD will comprise a literature review and exploration of three novel research questions about deprescribing.

Firstly, it investigated whether pharmacists and medical practitioners agree in selecting medicines to stop for older people living in residential care facilities, most of whom had dementia.

Secondly, it will develop an Australian consensus-based list of explicit prescribing criteria for older people living with dementia.

Thirdly, it will present strong randomised data describing the frequency and type of drug withdrawal events that occur when commonly prescribed medicines are ceased.

Why my research is important

In Australia, one in three older people (approximately one million people) take five or more medicines; nearly one in five are taking 10 or more medicines. This is called polypharmacy, and it's associated with more falls, more side effects, more hospitalisations, and even premature death.

Polypharmacy is particularly common among older people as many have multiple chronic diseases. Dementia, for example, is the number one cause of disability burden and the third largest cause of death among Australian adults, but many sufferers have other problems too.

Medicines are used to improve survival and quality of life, and doctors follow the treatment guidelines for the disease they are managing. But guidelines generally consider only that one disease; they are not designed for people with multiple issues.

Further, guidelines are based on evidence from younger people. Medicines may affect an older person differently because, even in normal ageing, our bodies change. Our kidneys and liver don’t work as well, and we have less muscle mass.

Yet clinical trials including older people are rare. In fact, only 3% of randomised controlled trials include people aged over 65. Most trials exclude people who can’t give informed consent, so dementia sufferers are out.

Deprescribing is proposed as an intervention to reduce the harmful overuse of medicines in older people. Deprescribing is thus defined as the systematic withdrawal of unnecessary or potentially inappropriate medicines, with the goal of improving health outcomes.

My research aims to explore which medicines should or shouldn't be used for people living with dementia to ensure the longest possible good quality of life through improved medicine use. Better medicine use could mean a vastly better quality of life for those living with dementia. Dementia is a disease that will, in time, affect more than one in ten people who live to 65.

Funding

  • University Postgraduate Award
  • Top-Up Scholarship
  • ““Concordance of deprescribing recommendations made by pharmacists and medical practitioners for frail older people living in residential aged care” Pharmaceutical Society of Australia (Western Australia)