Mixing multiple medicines, workplace mental health, and a check-up for Aussie tweens

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Health Report 28 min 3 speakers 4 chapters transcribed 6 days ago

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Unknown 0:01

This is an ABC podcast.

James Bullen 0:06

Hello and welcome to The Health Report with me, James Bullen. Today, who's responsible for managing your mental health in the workplace? An exercise prescription for Australian tweens and the growing issue of multiple medication use. When someone is using five or more medications at the same time, it's known as polypharmacy. It's thought to be common among older Australians with chronic illness, but we've lacked a clear picture of exactly how prevalent it is and whether it's on the increase until now. A new analysis published today in the Medical Journal of Australia has found that polypharmacy could be placing as many as one million older Australians at higher risk of falls, hospitalisation and frailty.

James Bullen 0:49

The lead author of the paper is Dr Amy Page, an adjunct senior lecturer at the University of Western Australia. Amy, welcome to The Health Report.

Amy Page 0:58

Thank you, James.

James Bullen 0:59

So, Amy, we should say up front polypharmacy isn't necessarily a bad thing, is it?

Amy Page 1:05

No, a lot of people are living with a medical condition or multiple medical conditions and some of these conditions need and benefit from medicines. We've now got a range of different medicines that are effective in preventing heart attacks, strokes and fractures. And we've got a range of medicines that can alleviate symptoms of many common conditions. Medicines that make us feel better when we've got a headache or nausea or gastric reflux or other unpleasant symptoms. But medicines can also have side effects. And the more medicines we take, the more likely we are to experience those side effects.

James Bullen 1:39

And what are some of those side effects specifically?

Amy Page 1:42

So there's no direct evidence that taking multiple medicines causes harm, only that it's linked to an increase of those risks of harm. So those sort of harms are the risk of having a fall, increased hospital admissions, increased risk of being frail.

James Bullen 1:57

Yeah, sure.

What is polypharmacy and why is it a concern for older Australians?

James Bullen 1:57

And so what's an example of the sort of patient who might experience polypharmacy? Who are they? What do they look like?

Amy Page 2:05

So we only looked at people over 70 in our research, and we weren't able to look at who was likely to be using multiple medicines. What we've seen from previous research is that the use of multiple medicines is very common in specific subpopulations, such as people who are living in residential aged care facilities or those who are currently in hospital. So what we wanted to do was have a look at whether this was just as common or how common it was amongst the population as a whole.

James Bullen 2:33

And just before you get to the research, and I know this wasn't a particular focus of the study today, but in some cases polypharmacy is caused by something called a prescribing cascade. What is that?

Amy Page 2:45

Yes, that's correct. So we know that sometimes people can start a new medication and that medication can cause a side effect. And instead of recognising that that side effect is actually a side effect, it's identified as a new condition for which a new medicine is prescribed. So a common example of this is that a lot of medicines can cause constipation. So instead of the constipation being identified as a side effect, it's identified as a new condition and a laxative is prescribed.

James Bullen 3:15

And then the new drugs might interact and there might be new effects and on it goes. And so what did you do in this particular study?

Amy Page 3:23

So in our study, we looked at a 10% random sample of people who were eligible for medicines listed on the Pharmaceutical Benefits Scheme, or the PBS, which is usually Australians who hold a Medicare card. So our study was based on a nationally representative sample of PBS prescribing data for older people, which actually means that it's the first to investigate patterns of multiple medicine use across all older Australians instead of just specific subgroups.

James Bullen 3:51

And what did you find?

Amy Page 3:52

We found that almost one million older Australians, so people aged over 70, were using five or more prescription medicines every day. This number had grown by 50% since 2006. And our estimate could actually be low because we were only able to consider those medicines that are subsidised by the PBS.