Multimorbidity, optimising treatment and preventing hospital admissions in older people

Multimorbidity is common among older adults. Now that people are living longer, they are also living with multiple conditions. The conditions may require a range of services and treatments, and often a case manager to discuss complex needs following an assessment, with the wider multidisciplinary team. A commonly found contributing factor to patients' deteriorating level of function on assessment may be inappropriately prescribed medication, mismanagement of medications and sometimes issues associated with polypharmacy.

Multimorbidity is defined as two or more chronic medical conditions. These increase with age and are seen at an estimated prevalence of 70% or greater across older populations aged 65 years and over. This accompanies increases in mortality, use of healthcare services, hospital admissions, and prescription rates of long-term medications, which often results in polypharmacy. While multiple medications may be indicated for some, this situation may present high risk in others.

The risks that inappropriate prescribing bring can commonly include overuse of drugs (prescription of medication without an evidence base for this), underuse of drugs (omission of prescription of medication despite evidence indicating its need), and drug misuse, whereby inappropriate combinations of medications may be prescribed, that result in drug interactions and inappropriate dosing (Daleur et al, 2015). Inappropriate prescribing has been found to be highly prevalent among older people and may lead to adverse outcomes, whereby drug-related hospital admissions, falls, mortality, and decreased quality of life have arisen from inappropriate prescribing in the context of polypharmacy (Chan et al, 2001). It is estimated that as many as 30% of hospital admissions in older people are linked to drugs, half of which are potentially preventable (Leendertse et al, 2008). Various interventions have therefore been designed to optimise pharmacotherapy in people with polypharmacy, with the aim of improving drug appropriateness and lowering the risk of adverse drug reactions.