(174) Symptomatic and Preventive Medication Use in Frail Nursing Home Residents in Australia and Japan

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 848

Presenting Author(s)

Shin Liau
– Pharmacist & PhD Candidate, Centre for Medicine Use and Safety, Monash University, Australia, Centre for Medicine Use and Safety, Monash University, Australia, Melbourne, Victoria, Australia

Co-Author(s)

Shota Hamada
– Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan, Japan
Agathe D. Jadczak
– National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Australia, Australia
Nobuo Sakata
– Setagaya Memorial Hospital, Tokyo, Japan, Japan
Samanta Lalic
– Pharmacy Department, Monash Health, Melbourne, Victoria, Australia, Australia
Renuka Visvanathan
– National Health and Medical Research Council (NHMRC) Centre of Research Excellence in Frailty and Healthy Ageing, Australia, Australia
J. Simon Bell
– Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Victoria, Australia, Australia

Background: Frailty may be an effect modifier for medication benefits and harms. Frailty screening may help guide treatment optimisation as residents’ goals of care shift from chronic disease prevention to comfort-oriented care and maintaining quality of life.

Objectives: To investigate the use of symptomatic and preventive medications according to residents’ frailty status in residential aged care services (RACS) and nursing homes (NHs) in South Australia and Kanto region, Japan.

Methods: Cross-sectional data were analysed from 12 RACS in South Australia and 4 NHs in Kanto region, Japan. Data were collected in 2019 in Australia and 2020 in Japan. Frailty status was assessed using the validated 7-item FRAIL-NH scale (non-frail 0-2; frail 3-6; most-frail 7-14). Regular medications were categorised as symptomatic or preventive based on published lists and expert consensus.

Results: Overall, 550 Australian residents (median age 89 years; IQR 84-92; 73% female) and 333 Japanese residents (median 87 years; IQR 83-91; 73% female) were included. In Australia, 42% and 46% of residents were frail or most-frail respectively. In Japan, 25% and 62% of residents were frail or most-frail respectively. Most-frail residents received the highest mean number of medications in Australia (10.1 ± 4.0) and Japan (6.9 ± 3.4). Preventive medications (56%) were more prevalent than symptomatic medications (44%) irrespective of frailty status or age in Australia but not in Japan. In Australia, mean symptomatic medications were more prevalent with increasing frailty (non-frail: 3.7; frail: 4.2; most-frail: 4.8) but less prevalent with age ( <80 years: 5.0; 80-89 years: 4.6; ≥90 years: 4.1). In Japan, a ratio of symptomatic to preventive medications of 1.3 was observed across all frailty status and age groups. Among most-frail residents in Australia, paracetamol (76%), vitamin D analogues (55%), and contact laxatives (45%) were the most prevalent medications used. In Japan, osmotic laxatives (55%), proton pump inhibitors (51%), and calcium channel blockers (34%) had the highest prevalence among most-frail residents. Irrespective of frailty status and age, the most frequently prescribed medications were paracetamol (69%) in Australia and osmotic laxatives (56%) in Japan.

Conclusions: Residents who were most-frail used the highest number of medications in these two Australian and Japanese cohorts. Increasing frailty was associated with higher use of symptomatic medications in Australia but this did correspond to lower use of preventive medications. Preventive medications appear to be continued regardless of increasing frailty status in both Australia and Japan, albeit at lower levels in Japan.