A research initiative led by the Kolling Institute is helping clinicians identify and reduce potentially harmful medications in older hospital patients, improving medication safety and supporting healthier ageing.
Medications play an important role in managing health conditions, but some can compromise physical and cognitive function.
Researchers at the Kolling developed the Drug Burden Index, a tool that measures a person’s total exposure to medications with anticholinergic and sedative effects. The cumulative impact of these medications can compromise both physical and mental health.
To explore how the tool could improve medication management in hospitals, researchers integrated the Drug Burden Index calculator into electronic medical records and recruited a pharmacist to help clinicians use the tool to guide medication reviews.
The team conducted a randomised controlled trial across six hospitals in the Northern Sydney and Central Coast local health districts.
The results showed the intervention had a positive impact, with a reduction in the use of medications with anticholinergic and sedative effects among older hospital patients – and an increase in recommendations to general practitioners to deprescribe these medications once patients left hospital.
Head of the Kolling Institute’s Laboratory of Ageing and Pharmacology Professor Sarah Hilmer welcomed the findings.
“After 20 years of research developing, validating and implementing the Drug Burden Index, it is great to see that it can be used in hospital care to help clinicians identify and reduce the use of anticholinergic and sedative medications in older patients.
“While we found that deprescribing was already common practice for the most frail patients, we saw that the intervention had a greater impact on clinical practice for patients who were less frail.
“This is particularly important because the use of these medications can increase the risk of worsening frailty,” she said.
“Our research also showed that the effect on deprescribing was not sustained when the intensive stewardship pharmacist intervention ended, indicating a need for ongoing stewardship or alternative strategies.”
Researcher Nashwa Masnoon said it was encouraging to see the stewardship approach clearly helped doctors, pharmacists and nurses identify and safely reduce potentially harmful medicines in older patients in hospital.
“We are excited to translate our research into practice to improve medication safety, quality of care and outcomes in older people,” she said.
Research fellow Kenji Fujita said the research demonstrated the value of assessing routinely-collected hospital data.
“This research was made possible by analysing large-scale data from hospital electronics medical records,” he said.
“Our work was assisted by a large language model which was used to analyse discharge summary deprescribing recommendations.
“It’s a great example of how routinely collected hospital data at-scale can directly help improve care for older inpatients,” he said.
The study represents an important collaboration between researchers, clinicians and consumers from the Northern Sydney and Central Coast local health districts, alongside national and international experts.
It’s hoped the intervention will be adopted on a larger scale, escalating the health benefits for a larger share of the community.
The research has been published in the prestigious JAMA Medicine journal.
