Abstract:
Medication reviews form the backbone of pharmacotherapy optimisation among the older population. Acknowledging the association of frailty and quality of life with medication appropriateness is beneficial in optimising medications among the elderly. This study developed an individualised approach to medication management among older people residing in aged care facilities, and assessed their frailty and quality of life. The approach is centred on medication appropriateness and comprises a five-step medication review algorithm that is supplemented with a 10-component tool, the Medication Appropriateness Index-Geriatric version (MAI-G). The MAI-G incorporates geriatric components and is useful in quantifying medication appropriateness. The components in the MAl-G closely correspond to components in the algorithm to allow for quick and unequivocal extrapolation. The algorithm and MAI-G were implemented in a 6-month prospective study among 202 residents aged 65 years and above across 17 aged care facilities in Klang Valley, Malaysia. The mean age ± standard deviation of the participants was 76.81 ± 7.79 years, with females dominating the study population (62.4%). The number of inappropriate medications detected by the MAI-G decreased from 0.83 ± 0.93 at baseline, to 0.76 ± 0.92 at 6- months. The proportion of inappropriate medications detected by the MAl-G that were not detected by the MAl was high, 39.7% at baseline, 34.8% at 3-months and 34.3% at 6-months. Interestingly frailty and quality of life status improved at 6-months although there was no statistically significant association between medication appropriateness and the risk of reporting frailty (OR 4.64, 95% CI: 0.83-25.76), or medication appropriateness and the risk of reporting poor quality of life, at 6-months (OR 1.60, 95% CI: 0.47-5.49). This study provides an overview of the frailty and quality of life status of aged care residents in Malaysia, and suggests that urgent attention from health care professionals is warranted, to improve their health care, particularly the prescribing of potentially inappropriate medications. The findings support the need for a comprehensive medication review process that is supplemented by a medication appropriateness quantification tool which is geriatric-specific.
