Blog

For the past 20 years, Professor Sarah Hilmer has dedicated her career to optimising medicine use for older people and has achieved recognition as a national and world leader in geriatric pharmacology.

Not only has the Royal North Shore Hospital clinical pharmacologist and geriatrician set about improving medication practices for older people, but she has long advocated for ‘age-friendly’ clinical trials.

One of Sarah’s notable contributions has been the development of the Drug Burden Index (DBI), a risk assessment tool that measures an older person’s exposure to medications that slow them down physically and mentally.

“Over the past 20 years or so, we have been validating the tool in populations around the world to show that the higher your Drug Burden Index, the worse your physical function and your cognition is, and the more likely you are to fall or wind up in a nursing home,” she says.

Eager to put the initiative into clinical practice, Sarah and her colleagues developed a calculator that could measure a patient’s drug burden. They produced a way to integrate it into a hospital’s electronic medical record so that staff could use it when treating frail, elderly patients.

In 2021 — at the height of the pandemic — Sarah ran a successful pilot study implementing the calculator at Royal North Shore. “We managed to show that we could really improve prescribing,” she says.

For the past 18 months, she and her team have run a clinical trial in three hospitals in Northern Sydney and three on the Central Coast to see if this package of tools can help clinicians to identify patients who are not functioning optimally because of the medication they have been taking and to minimise medication related harm.

The tools are now available for clinical care across the Northern Sydney and Central Coast health districts and are being implemented at other NSW health districts.

Sarah is eager to see the tool as part of routine hospital care.

Nurses regularly have a “huddle” to discuss patient issues, which can include falls or delirium. Her team has been encouraging nurses to look at the Drug Burden Index during a huddle, and if it is high, arrange for a medication review.

“It might be that the medication is causing the falls or confusion,” she says.

Sarah has long advocated for ‘age-friendly’ clinical trials that make it easier for frail, older people to be included.

While the average older person takes up to eight prescription medications, globally, they are often underrepresented in clinical trials.

“We have a situation where we test drugs in healthy, older people or in middle aged people, and then use them in frail, older people with a lot of different complex problems. We wind up with all sorts of interactions and unexpected effects.”

“I think it’s really important that if we’re going to do clinical trials, we need to make sure that they’re inclusive of the people who are going to actually wind up using the drugs in clinical practice,” she says.

Her advocacy in this space extends beyond Australia. The U.S. Food and Drug Administration recently designed a roadmap for drug evaluation for older adults, and Sarah was the only Australian on the project, representing the Geriatric Committee of International Union of Basic and Clinical Pharmacologists, which she chairs.

Sarah’s work through development and implementation of the Drug Burden Index and her advocacy for age-friendly trials has significantly improved the quality of life for older adults. “We need to ensure our ageing population receives the best possible evidence-based care,” she says.