The bottom line

June 2010


Quality use of medicines in residential aged care

Volume 39, No.6, June 2010 Pages 413-416

Michael Somers

Ella Rose

Dasha Simmonds

Claire Whitelaw

Janine Calver

Christopher Beer


Older people are more likely to be exposed to polypharmacy. People with dementia, especially those living in residential aged care facilities (RACFs), are at particularly high risk of medication harm. We sought to describe medications prescribed for a sample of people with dementia living in RACFs.


A total of 351 residents with dementia aged over 65 years were recruited from 36 RACFs in Western Australia. Data on all medications prescribed were collected, including conventional medications, herbal medications, vitamins and minerals.


Polypharmacy was identified in 91.2% (average 9.75 medications per person); one-third were prescribed an antipsychotic medication; and 50.4% were found to be taking at least one potentially inappropriate medication. The combination of antipsychotics and antidepressants was the most frequently observed drug-drug interaction, being prescribed to 15.7% of participants.


People with dementia living in RACFs are commonly exposed to polypharmacy. Prescription of contraindicated medications, antipsychotics, medications with high anticholinergic burden, and combinations of potentially inappropriate mediations is also common. There may be substantial scope to improve prescribing for older people with dementia living in RACFs.

Approximately 190 000 people in Australia were estimated to have dementia in 2006, with the prevalence expected to increase to 465 000 by 2031.1 The prevalence of dementia increases with age, from 6.5% of Australians aged 65 years and over to 22% of Australians aged 85 years and over.2 Dementia is associated with a large burden of disease in Australia’s aging population, costing Australia $1.4 billion in 2003.2 Most of this burden was associated with residential aged care facilities (RACFs).2 Dementia is the medical problem most frequently managed by general practitioners attending RACFs.3 Ninety-six percent of people with dementia living in care accommodation in Australia have moderate or severe dementia, compared to only 7% of people with dementia living in households.1 Therefore people requiring residential care tend to be among the frailest and sickest in the community, with substantial physical and behavioural needs and multiple comorbidities.

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