Kerrie Westaway

Medicines can affect thermoregulation and accentuate the risk of dehydration and heat-related illness during hot weather.

Hot days are increasingly common and are often associated with increased morbidity and mortality, especially in the elderly. Most heat‐related illness and heat‐related deaths are preventable.

Prevalence of multiple antipsychotic use and associated adverse effects in Australians with mental illness.

Aim:This article analyzes the prevalence of use of concurrent multiple antipsychotics and high dosage treatment in people with mental illness, to assess the burden of antipsychotic drug-related side-effects associated with multiple use, and to identify strategies shown to reduce antipsychotic polypharmacy. Methods:Literature reviewed was sourced from MEDLINE, Embase, CINAHL, InformIT, PsycINFO, International Pharmaceutical Abstracts, Cochrane Library database and Joanna Briggs Institute databases to identify Australian studies published between January 2000 and February 2015. Studies that reported prevalence of multiple antipsychotic use or addressed the issue of antipsychotic drug-related side-effects were included. Systematic reviews, randomized controlled trials, and observational pre–post studies of Australian and international interventions aiming to reduce multiple antipsychotic use in mental health settings were also identified. Results:Nineteen studies reporting prevalence of multiple antipsychotic use were identified. The proportion of patients taking more than one antipsychotic ranged from 5 to 61%. Of the studies assessing dosages used, between one-third and one-half of all patients taking multiple antipsychotics received doses higher than recommended. Data from one national study reported that people taking multiple antipsychotics were more likely to experience at least one side-effect in comparison to consumers taking a single antipsychotic (90 verses 80%).International evidence of direct trials of conversion from treatment regimens involving multiple antipsychotics to those based on monotherapy show that between 50 and 75% of people with serious mental illness could be successfully converted to single-agent treatment, with up to 25% obtaining an improvement in health and the remaining 50% staying well managed. Conclusion:Use of multiple antipsychotics is common among Australian people with mental illness, despite guidelines recommending that only one antipsychotic should be used in most cases. People taking more than one antipsychotic at a time are more likely to experience side-effects, and to receive higher than recommended antipsychotic doses. Direct trials that aimed to reduce multiple antipsychotic use suggest it is possible to effectively reduce therapy in the majority of people without worsening outcomes. Simple educational programmes targeting health professionals have not been found to be effective; however, complex multifaceted programmes and quality improvement programmes have demonstrated effect.

Increased risk of hospital admission for dehydration or heat-related illness after initiation of medicines: a sequence symmetry analysis

Although several studies have identified factors which increase the risk of heat‐related illness, few have assessed the contribution of medicines. To address this knowledge gap, our study aimed to assess the risk of hospital admission for dehydration or other heat‐related illness following initiation of medicines.

Optimising therapy for patients with neuropathic pain

Neuropathic pain is a common condition that affects people of all ages, but is especially prevalent among older people because the incidence of many diseases that cause neuropathic pain increases with age. Neuropathic pain is often underdiagnosed or undertreated, and is associated with a diminished quality of life, significant disability and depression. The principal aim of management is to improve the patients quality of life by attaining maximum pain relief with minimal treatment‐associated adverse effects, and restoring functional ability. The current therapeutic options for the management of neuropathic pain are reviewed here, focusing on the importance of an accurate diagnosis and assessment, early intervention, regular clinical reviews and steps in pharmacological treatment.

Safe use of statins in elderly people

Multiple medicine use is common in older Australians, with statins (hydroxymethylglutaryl coenzyme A reductase inhibitors) being among the most commonly prescribed. While there is significant evidence that statins are of benefit in people at higher levels of cardiovascular risk, the risk–benefit ratio is less assured in those 80 years and older. High doses or high‐potency statins in elderly people may not increase effectiveness, but may increase the risk of adverse effects such as muscle‐related aches, pains and weakness. Hence, statin use in the elderly requires frequent review and consideration of their therapeutic goals, quality of life, risk–benefit ratio and life expectancy. This paper outlines steps to consider when an older person who is prescribed a statin experiences unexplained muscle‐related aches and pains or weakness.

The extent of antipsychotic use in Australian residential aged care facilities and interventions shown to be effective in reducing antipsychotic use: A literature review:

At least half of all residents of Australian residential aged care facilities have dementia. Most residents living with dementia will at some stage experience behavioural and psychological symptoms of dementia (BPSD), which can be challenging to manage and distressing for the resident, their family and carers. This literature review examined the prevalence of antipsychotic use in Australian residential aged care facilities, which may be used to manage BPSD only after non-pharmacological treatments have failed. Sixteen studies assessing care between 2000 and 2017 were identified and reviewed. The proportion of residents prescribed an antipsychotic ranged from 13% to 42%. Evidence from six Australian interventions showed that the antipsychotic use can be reduced, especially when non-pharmacological interventions that are individualised to the person and the behaviour are implemented. Research has shown that antipsychotics can be tapered and ceased without re-emergence of behavioural symptoms in many instances. Multidisciplinary, multi-strategic approaches have demonstrated effectiveness in reducing antipsychotic use by up to 3% (absolute reduction) in the aged-care setting.

Minimising fracture risk in older people taking long-term oral corticosteroids

Corticosteroids have potent anti‐inflammatory and immunosuppressant properties but are associated with a number of serious adverse events. When taken orally for longer than 3 months, particularly at prednisolone‐equivalent doses greater than 5 mg per day, corticosteroids are associated with a high incidence of bone loss, muscle atrophy and weakness. Fracture risk is increased as a result of corticosteroid‐induced bone loss and muscle weakness. Corticosteroid‐related fractures are a serious complication of long‐term oral corticosteroid therapy. The aim of this article is to provide practical information to help clinicians to minimise fracture risk in older people taking long‐term oral corticosteroids. When therapy is instigated for longer than 1 month, identify at‐risk patients promptly and consider a calcium and vitamin D supplement and fracture prevention therapy. Patients at risk include those receiving prednisolone‐equivalent doses of more than 5 mg per day for longer than 3 months and patients receiving frequent short courses of high‐dose corticosteroids.