The use of multiple medications in older people can significantly contribute to harm but in most cases steps can be taken to reduce risk.
Of all medications prescribed in the UK, 45% are for older people aged 65 and over, and 36% of people aged over 75 take four or more prescribed drugs (Department of Health, 2001). The resources in this section highlight strategies to improve medication safety in older people.1
Polypharmacy is common in older people with multiple co-morbidities and is a significant contributing factor to harm for these patients. There is good evidence that strategies, such as medication reconciliation, can reduce harm from polypharmacy. Noel Ballantine explores these in his paper, Polypharmacy in the elderly: maximizing benefit, minimizing harm. The paper combines a review of the current problems of polypharmacy with suggestions of interventions to minimize harm and strategies to implement these.
Learning from best practice improvement reports is a key approach to improving patient safety. Improving staff perception of patient safety, help service users to feel safe on the ward and improve medication safety project from Hampshire Partnership NHS Trust and the Health Foundation describes interventions to improve medication safety and medication reconciliation. The use of novel documentation and improved communication with primary care were the main interventions trialed.
The Institute of Healthcare Improvement have recorded an interview with Dr Michael Steinman, author of Managing medications in clinically complex elders. During the interview, Dr Steinman draws out key learning from his paper which uses the literature evidence base to underpin a patient-centred approach to medication prescribing. He emphasises the need to individualise goals and understand the particular patient experience of medication to reduce harm and simultaneously improve experience.
- National Service Framework for Older People. London: Department of Health, 2001.