Frequently asked questions – National Medicines Symposium 2024

Polypharmacy is when people are using five or more medicines at the same time. The concurrent use of multiple medicines is common in older people because they are more likely to have several chronic diseases that require management with medicines. Although polypharmacy may be appropriate for some older people, it can increase the risk of harm from medicines because there is a greater chance of taking medicines that could interact, and a greater chance of making mistakes with medicines. Older people are also more sensitive to the effects of medicines.

In Australia, polypharmacy is a growing concern in older people as it increases the risks of medication-related harm. Potential harm includes delirium, falls, frailty, cognitive impairment and hospitalisation. It is important to note that adverse events resulting from polypharmacy can have negative consequences that extend beyond the risks associated with individual medications. 

Monitoring and responding to inappropriate polypharmacy was identified as one of the actions for Australia’s response to Medication Without Harm – WHO Global Patient Safety Challenge. Raising awareness of polypharmacy and discussing practical strategies to safely manage patients who take several medicines, including discontinuing medicines no longer appropriate for their care, was an important objective of the National Medicines Symposium 2024. 

In Australia, 40% of older adults aged 75 years and over were dispensed more than five medications at the same time in 2022. This was higher than the Organisation for Economic Co-operation and Development (OECD) average of 32%. Among the countries that reported data for this indicator, Türkiye had the lowest rate of 5.4%.
- Source: OECD health care quality and outcomes indicators, Australia 2022–23, Australian Institute of Health and Welfare 2024

Australia has established guidelines and frameworks, such as the National Medicines Policy aimed at ensuring appropriate medication use.

Some of the key initiatives Australia has undertaken to address polypharmacy are included in the Status report on Medication Without Harm – WHO Global Patient Safety Challenge: Australia’s response. The Status report examines the impact of programs implemented to address the priority actions identified in the three WHO flagship areas:

• Monitoring polypharmacy and responding to inappropriate polypharmacy
• Reducing harm from high-risk medicines
• Improving medication safety at transitions of care.

There are a number of Australian Government Department of Health and Aged Care funded Pharmacy Programs that support the quality use of medicines including: 

• Home Medicines Review, which involves pharmacists visiting patients in their home and collaboration between patients, doctors and other members of their healthcare team and their carers to reduce the number of adverse medicines events
• Dose Administration Aids program, which assists people with the management and timing of their medicines
• Residential Medication Management Review, which supports a pharmacist’s comprehensive assessment of a resident’s medications and medication-related healthcare interventions
• Quality Use of Medicines service, which supports improvement of practices and procedures and safe use of medicines in residential care facilities, and
• Aged Care On-site Pharmacist Measure, which supports community pharmacies and residential aged care homes to employ pharmacists to work alongside other aged care professionals to improve medication management and ensure older people are using their medications safely.

Deprescribing is the process of systematically reducing or stopping medications that may no longer be necessary, effective or safe for a patient.

Deprescribing unwanted or inappropriate medicines can:

• Reduce medication burden
• Improve safety through reduction in adverse medication interactions, side effects and complications associated with polypharmacy
• Enhance adherence to medicines
• Promote patient-centred care through aligning treatment with patient’s values and goals. 

Approaches to deprescribing and how it may improve outcomes for older patients has been discussed in keynote presentations and panel discussions in Session 2 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recordings. A compendium of resources is also available for reference.

This question was answered as part of the panel 1 discussion in Session 1 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording. 

This question was answered as part of the panel 2 discussion in Session 2 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording.

Examples of medicines that contribute to adverse effects in older Australians include:

• Medicines with anticholinergic properties
• Benzodiazepines
• Antipsychotics
• Proton pump inhibitors
• Antimicrobials
• Nonsteroidal anti-inflammatory drugs. 

These medicines can increase the risk of falls, cognitive impairment, confusion, delirium and other serious side effects in older patients.

Deprescribing requires a tailored approach based on a patient’s health conditions, medical history and current medications, as well as their individual needs and preferences. It may also require discussions between the patient and/or their carers and multidisciplinary team involved in their care including general practitioners, pharmacists, nurses, specialists and others as appropriate.

Approaches to deprescribing and how it may improve outcomes for older patients has been discussed in keynote presentations and panel discussions in Session 2 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recordings.

This question was addressed as part of the panel 1 discussion in Session 1 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording.

Person-centred care, including information that supports shared decision-making and the right to make choices, is essential for the quality use of medicines and medication safety. Clinicians can ensure alignment by:

• Encouraging patients and/or carers to be active, empowered and informed participants in shared decision-making
• Embracing wisdom and experiences of patients and/or carers in a shared decision-making partnership with health professionals
• Encouraging people to ask for and use objective, evidence-based, trusted, reliable and good quality information, resources, and services as part of a shared approach to informed decision-making
• Developing the skills and confidence of people to manage their own health and medicines, including when and where to get help, when needed
• Providing patients and/or carers with access to clear, consistent, standardised, timely, objective, credible, up-to-date information on medicines use appropriate to their needs.
• Providing culturally safe, person-centred services and support for both face-to-face and non-face-to-face interactions
• Providing prompt, appropriate, targeted and tailored support for people to understand the risks and benefits of medicines and the role of other options to achieve the best health outcomes. 

Source: National Medicines Policy 2022

This question was examined as part of the panel 1 discussion in Session 1 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording.

This question was examined as part of the panel 1 discussion in Session 1 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording.

Some of the steps to reduce medication-related harm in aged care settings include:

• implementing medicine reviews, 
• facilitating clinician training on the risks of polypharmacy, 
• enhancing communication among clinicians, 
• and emphasising the need for individualised medication plans that consider a patient's health and personal values and goals.

This question was examined as part of the panel 1 and panel 2 discussions in Session 1 and 2 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recordings.

The theme for the National Medicines Symposium 2024 was “Appropriate use of medicines in an ageing population”. The Symposium aligns with the WHO's Global Patient Safety Challenge: Medication Without Harm by focusing on all three of its areas:

• Monitoring and responding to inappropriate polypharmacy by raising awareness of the risks associated with polypharmacy in older adults and promoting safe and sustainable use of medicines
• Reducing harm from high-risk medicines by highlighting approaches for safe and appropriate prescribing of high-risk medicines
• Improving medication safety at transitions of care through communication and leveraging digital tools.

Some of the ways in which digital health tools can empower patients include providing accessible medication management apps, telehealth services, and educational resources that inform patients about their medications. 

Digital health tools and systems can also empower clinicians by streamlining medication reconciliation processes, improving tracking of prescription histories, supporting medication prescribing and dispensing through alerts for potential medication interactions or errors, facilitating better communication among clinicians through electronic health records, and enabling better collaboration for patient care.

This question was examined as part of the panel 3 discussion in Session 3 of the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recording. 

Tools and resources supporting the appropriate use of medicines in older Australians have been discussed in keynote presentations and panel discussions across the National Medicines Symposium. Please refer to safetyandquality.gov.au/NMS24 to view the recordings. 

A compendium of resources is also available for reference. 

The Australian Commission on Safety and Quality in Health Care (the Commission) works to improve the safety and quality of medication use in Australia by leading and coordinating national initiatives to reduce medication errors and harm from medicines. The key programs and resources developed by the Commission to support this initiative have been listed in the compendium of resources available at safetyandquality.gov.au/NMS24. Please note some resources are not specific to an ageing population. The principles in resources to support appropriate use of medicines across all age groups and settings, can also be applied to supporting the appropriate use of medicines in the ageing population.