Ageing is associated with the development of chronic illness and the implementation of guidelines for the management of these conditions has resulted in an increase in the cost and number of prescribed medications. Older people are the major recipients of medications with those aged over 65 contributing to over half of all Pharmaceutical Benefits Scheme expenditure. There is increasing concern that the prescription of multiple drugs for older people can cause significant harm. Pharmacokinetic and pharmacodynamics changes with chronological age increase the risk of adverse drug events. In community-dwellers, polypharmacy (defined as the use of 5 or more medications per day) is associated with falls, functional decline and mortality. On the other hand, medication can be of considerable value to older people, improving quality of life through symptom control, preventing cerebrovascular morbidity and reducing cardiovascular mortality.

At CRGM, we are investigating the effect of multiple medications on outcomes in older people. Our understanding of frailty provides a unique and innovative perspective to these studies. We hypothesise that frail older people may be more vulnerable to the adverse effects of drugs whereas those who are fitter may gain more benefit. The large and comprehensive datasets available for interrogation include older inpatients across multiple hospitals assessed using the interRAI Acute Care tool and very dependent older people in Residential Aged Care Facilities.

This work is led by Associate Professor Ruth Hubbard.