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Medication management for older persons can be complex. With over 50% of all hospital admissions being for people aged over 65 years, understanding age-related functional, cognitive and social factor changes and their impact on medication use is critical for pharmacists working in most adult medicine areas. This paper provides an overview of critical elements of medication management for older persons for pharmacists. Key elements include age-related changes impacting medication effectiveness and safety, frailty, geriatric syndromes, polypharmacy and deprescribing, minimising medication-related harm at transitions of care, dose administration aids and other strategies to support individuals in medication management and multidisciplinary comprehensive geriatric assessment.

Background: Prescribing quality is a major issue in nursing home patients. Few cross-national comparisons of prescribing patterns have been carried out in this population. Objectives: To compare prevalence of medication use in nursing home patients between Australia and The Netherlands. Methods: An analysis of medication use based on pharmacy dispensing data was undertaken for residents in nursing homes in Australia (AU) and the Netherlands (NL). The data included residents >65 years old who remained in a high care nursing home in 2009 in AU (n = 1,560) or NL (n = 2,037). Annual prevalence was defined as the dispensing of 1 or more prescriptions for a drug during the study year expressed as percentage of all residents. Multiple logistic regression was used to calculate the prevalence odds ratios (OR) and associated 95% confidence intervals (CI), adjusted for gender and age. Results: The mean age of residents was 85.8 (SD 7.5) (AU) and 82.8 (SD 7.5) (NL), the majority were female (AU: 70.3%, NL: 68.2%). Residents used a mean of 11.4 (SD 5.3) (AU) and 10.8 (SD 7.0) (NL) drugs. The prevalence of medication use was similar in the two countries for most ATC groups. Major differences were observed in the use of benzodiazepines (anxiolytics: AU: 14.1%, NL: 27.8%, OR 0.41 (0.37-0.53)), osteoporosis medication (AU: 51.2%, NL: 28.9; OR 2.56 (2.22-2.96)). Overall use of antipsychotics (AU: 37.7%, NL: 40.3%; OR 0.91 (0.79-1.04)) was similar, but choice of individual drugs differed, e.g. haloperidol (AU: 8.2%, NL: 19.7%; OR 0.34 (0.27-0.42)) and risperidone (AU: 17.4%, NL: 7.3%; OR 2.86 (2.30-2.57)). Systemic antibacterials (AU: 66.8%, NL 62.4%; OR 1.08 (0.93-1.24)) and cardiovascular system drugs (AU: 73.8%, NL: 72.9%; OR 1.05 (0.90-1.23)) overall were similar but major differences were also found in the choice of agents. Conclusions: There are many similarities, but also striking differences in prescribing patterns for nursing home patients between Australia and the Netherlands. Differences in policies, guidelines, education/training and cultural beliefs are possible explanations. Investigating this further should improve our understanding of the various influences on prescribing in nursing homes.

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