Older People’s Health and Wellbeing
A 50% rise in the proportion of people over 65 years in Scotland is predicted by 2033, their care is a priority in Scotland and beyond.
Older People’s Health and Wellbeing: Safer Prescribing
Although medicines can substantially contribute to prolonging and enhancing the quality of life, harm caused by medicines is an internationally recognised problem And a threat to public health. It is estimated that 3% to 4% of all unplanned hospital admissions are caused by preventable adverse drug events, of which two thirds are associated with high risk prescribing or monitoring. Older people who take multiple medicines (polypharmacy) are particularly at risk of medicines related harm, which may range from minor physical harm (but major implications for quality of life, such as constipation or sedation) to medical emergencies (such as gastrointestinal bleeding or kidney failure) requiring hospital admission.
The prevalence of multimorbidity and polypharmacy is rising. In Scotland, 1 in 5 adults and 59% of people over the age of 70 are dispensed 5 or more medicines as demonstrated by Healthcare Improvement Scotland's infographic, and with an aging population, polypharmacy is becoming the norm rather than an exception. There is therefore an urgent demand for developing and implementing effective and sustainable medicines management services to reduce the risk of harm and improve health and wellbeing for older people.
The Data-driven quality improvement in primary care (DQIP) programme provided proof of principle that the provision of an IT tool (to facilitate the identification of patients at risk of adverse events for review), financial incentives and education to general practices can significantly reduce high-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelets and prevent related hospital admissions.
Our Current Focus
The aim of this project is to build on the positive preliminary results from the DQIP programme by broadening the scope of the intervention (to include a wider range of high-risk prescribing and monitoring) and by increasing capacity in primary care to provide medicines management. Through the stages of this research, we aim to develop, implement and evaluate a pharmacist-supported and IT facilitated intervention to manage high-risk prescribing and monitoring in primary care. It is anticipated that improved systems for identifying and managing high-risk polypharmacy will substantially reduce preventable drug adverse effects, including drug related hospital admissions, which account for up to 4% of all emergency hospital admissions in the UK.
What’s Been Happening?
Optimising the intervention – Presentation on the next steps of implementing routine management of patients at high risk of drug related morbidity.
(1) Impact evaluation (April 2017):
- Assess the impact of the intervention on high-risk prescribing
- Assess the impact on the intervention on emergency care utilisation
- Economic evaluation
(2) Process evaluation:
- Explore any variation in effectiveness
- Understand how context impact on effectiveness
University of Dundee
All publications linked to the DQIP projects can be accessed here.
Guthrie B, et al. High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice. BMJ 2011;342: d3514
Guthrie, B., Dreischulte, T. et al, The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010. BMC Med. 2015; 13:7
Dreischulte T., et al, 2016. Safer Prescribing-A Trial of Education, Informatics, and Financial Incentives. New England Journal of Medicine, 374(11), pp. 1053-1064
Guthrie, B, et al. Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial, BMJ (2016). DOI: 10.1136/bmj.i4079
DQIP 2 is supported by:
Scottish Government Therapeutics Branch/Albasoft
Scottish Therapeutics Utility
Endowment fund: GP cluster participation fee
University of Aberdeen HSRU: Cost-effectiveness
Older People's Health and Wellbeing: Physical Activity
Safe, effective, multi-professional health and social care is required to keep older people healthy and independent. However, multiple morbidity means that direct translation of evidence into practice with older people is not always appropriate. Models to guide evidence implementation with this population in different care contexts are therefore vital.
Our Current Focus
In the first stages of our work focusing on physical activity and older people, we undertook a review of reviews looking at the effects and the nature of interventions to promote physical activity among community-dwelling older adults.
What’s Been Happening?
We established that multi-modal and multi-component interventions to promote physical activity were generally effective at increasing PA and improving general wellbeing of older adults. We also identified intervention components that were associated with positive outcomes and proposed that most promising intervention features may be adapted to suit the needs of ageing population, leading to even better effects.
We hope to publish the results of this review soon – if you would like a copy of this review when published – please click here!
A summary of the results can be found here