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NSAIDs overused and putting residents at risk

Researchers have found that NSAIDs, such as common Ibuprofen, are being overused in aged care, putting residents at risk.

The study – which looked at over 10 thousand residents during a three-year period – also found that the “triple whammy use” of oral NSAIDs, ACE inhibitors and diuretics, while rare, carries increased risk of acute kidney injury.

Co-author of the research Kim Lind said pain and arthritis-related pain are the most common reasons for oral NSAID usage, and as they are often available over the counter these drugs are seen as unlikely to be dangerous.

“We don’t want to see people on it for more than two weeks. That’s what Choosing Wisely Australia recommends,” Lind said.

Lind’s research showed that some residents with very severe pain had NSAIDs prescribed for the duration of their stay in aged care, which could amount to years.

“Talking about duration for people who use that triple whammy combination of drugs … there was a reasonable proportion of those people who were using them for quite a long time.

“A quarter of the triple whammy users were using those meds for over 20 per cent of their length of stay. That’s concerning when we know that people are in here for a really long time,” said Lind.

Although the research did not analyse mortality in relation to the medication use, Lind argued that overuse of the NSAIDs are likely to contribute to a resident’s decline without being noticed.

“It could be that somebody gets some medication, they start doing poorly, they may go to the hospital and I think providers are not always quick to notice that that’s just due to the medication combination, and that’s why the person is having kidney failure.”

Lind argued that facilities should be exploring and exhausting all available treatment options, moving away from over-reliance on NSAIDs and other medications.

Exercise and physiotherapy are often the best medicine, Lind said, and NSAIDs should be seen as a “last resort”.

Going forward, better regulation and oversight of medications is needed in aged care, and government and business need to work together to incorporate data tracking technologies, Lind argued.

“Getting the big software companies on board with putting the resources into developing and refining these systems and implementing them. Developing things like dashboards for aged care to give the providers the ability to easily look at their facilities and say, ‘Okay, what proportion of people do we have on NSAIDs? How many have been using them for longer than two weeks? How many people with heart failure are using and oral NSAID?’

“They’re just not easy to do right now for the providers, so we need to make it easier for them to do their job well, and I think technology is going to be the key to that,” said Lind.

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