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Australians are living longer than ever before. While this is broadly good news, ageing well comes with a range of challenges.

As people grow older, they’re more likely to develop multiple chronic conditions, including heart disease, diabetes, high blood pressure, and cognitive problems such as dementia.

These conditions often mean people need to take more medications. Around one in three Australians aged over 70 take five or more different medications. While these can be important, and even lifesaving, managing multiple medications can become a major challenge in itself.

We wanted to understand more about how older Australians use medications. In a new study, we looked at ten years of national data from the Pharmaceutical Benefits Scheme (PBS), which subsidises medications for eligible Australians.

Using a 10% sample of Australians between 2013-23, we examined how often people aged 65 and over visited prescribers and pharmacies for the dispensing of their PBS medicines. Prescribers included GPs and other medical specialists, for example.

We found older Australians visited their prescribers an average of five times a year and made 16 pharmacy visits annually for the supply of their PBS medications. In 2023, people over 65 had an average of 31 PBS-subsidised medicines dispensed throughout the year (this figure may include repeats of the same medicine).

We also found the number of older Australians using five or more regular PBS medications increased by 32% (from 1.03 million to 1.35 million) from 2013 to 2023, likely driven by population ageing.

It’s important to note our study only captured PBS-subsidised medications that were dispensed. Prescriptions that weren’t filled or those not subsidised by the PBS (such as over-the-counter medications and supplements) weren’t included, meaning the true number of medications older people are using is likely even higher.

While medications are essential for managing health, they can also pose risks. Taking more medications often means a higher likelihood of errors, side effects, drug interactions and hospitalisations.

What’s more, as we age, physiological changes such as reduced kidney and liver function can increase the risk of medication-related harms. Depending on the individual, it could come to a point where the risk of harm eventually outweighs the benefits of the medication.

Sometimes, when it comes to medications, less can be more.

As well as the physical health risks, managing multiple medications can be complex and demanding for older adults and their families. More medications mean more doctors’ visits, more trips to the pharmacy, and prescription costs can also quickly add up. All this can influence what daily life looks like for older people.

Let’s look at a hypothetical case study. Jean is 80 and lives on her own. She is on ten different medications for conditions including high blood pressure, high cholesterol, diabetes, arthritis, reflux and sleep problems. Some need to be taken multiple times a day, meaning she takes more than ten tablets daily.

Jean’s routine revolves around managing her medications, remembering what to take and when, coping with medication side effects including dizziness and tiredness, and making frequent trips to the doctor and pharmacy.

She’s stopped going to her weekly bowls game, and even lunch outings have become stressful as she needs to remember her pills and time them around meals. Her daughter helps with transport and picking up scripts, but the complexity of her medications has affected her lifestyle, independence, and enjoyment of life.

Although this case study is fictional, it reflects the circumstances many older people find themselves in with regards to medication use.

It’s important for older people taking multiple medications to talk to their doctor or pharmacist about whether their current medication regimen is still right for them, and how to manage their medication safely and effectively.

Many Australians, particularly older adults, could be eligible to be referred by their GP for a government-funded medication review. These medication reviews are conducted by a credentialed pharmacist and designed to help people get the most benefit from their medications while minimising any potential harms.

However this service remains under-utilised, which motivated a recent campaign to improve awareness and uptake.

Read more:
Taking more than 5 pills a day? ‘Deprescribing’ can prevent harm – especially for older people

Let’s return to Jean. Fortunately, she recently received a detailed medication review.

The reviewing pharmacist was able to make some practical changes to the timing of when Jean takes some of her medications. Also, by suggesting products that combine more than one medication in a single tablet, the pharmacist reduced the number of tablets Jean needs to take every day.

The pharmacist also worked with Jean’s community pharmacy to repackage Jean’s medications into a pill organiser and helped establish a reminder system to help Jean remember to take her medications at the correct times and when to refill her prescriptions.

Finally, the pharmacist queried several of Jean’s medications with her doctor in light of side effects and changes in her health status. As a result, the dose of one medication was halved, and another was discontinued.

Jean now plans to have her medications reviewed annually.

Older Australians tell us they want to enjoy happier, healthier and more fulfilling lives. With the right support, there’s a real opportunity to reduce the burden of taking multiple medications, and help older Australians like Jean not just live longer, but live well.