Where do we draw the line?

Denbigh Burrows (UNSW M.D. Year VI), Timothy Bemand (UNSW M.D. Year VI)

Abstract

Polypharmacy in the elderly is a common occurrence which can have catastrophic effects. With the rapidly growing amounts of prescription medication which are available, the last ten years has seen a concerted effort by health bodies and professionals to routinely review patients’ medications so to reduce unnecessary medications and the detrimental effects. However, so too often do we as clinicians see elderly patients, aged above 80 years, who are taking numerous medications to manage their multiple morbidities and are unsure as to whether these are benefitting or hindering patient outcomes.

Whilst the clinical consequences of polypharmacy in elderly patients is widely understood, we have not considered the idea of a medication limit - a constraint on the number of long-term regular medications elderly people should be prescribed. This original research aims to explore the ethical grounds of implementing a medication limit for all people over 80 years to help mitigate the effects of polypharmacy in the elderly population. To achieve this, we will conduct interviews with ten elderly inpatients (over 80 years old) who are taking more than seven regular long-term medications so to gain their perspective on the cessation and continuation of their medications.

Additionally, we aim to interview one first-degree relative to obtain their wishes regarding the number and necessity for the medications their loved one is taking. Finally, we will interview five practising medical specialists to determine their viewpoint on implementing a medication limit and its utility in medical practice.