Potentially suboptimal prescribing of medicines for older Aboriginal Australians in remote areas.

OBJECTIVES: To investigate the prevalence of polypharmacy, under-prescribing and potentially inappropriate medicine use among Aboriginal Australians living in remote Western Australia. DESIGN: Cross-sectional study. SETTING: Six remote communities and the town of Derby in the Kimberley, Western Australia. PARTICIPANTS: Aboriginal people aged 45 years or more with complete medication histories. MAIN OUTCOME MEASURES: Proportions of patients with medicine histories indicating polypharmacy, potential under-prescribing of indicated medicines, or potentially inappropriate prescribing (including potential prescribing cascades or drug interactions). RESULTS: Complete medicine histories were available for 273 participants. The mean number of prescribed medicines was 5.1 (SD, 3.6). At least one form of suboptimal prescribing was identified for 166 participants (61%), including polypharmacy for 145 (53%), potential under-prescribing of at least one indicated medicine for 33 (12%), and potentially inappropriate prescribing for 54 participants (20%). Potential prescribing cascades or drug interactions were identified for 12 participants (4%). CONCLUSIONS: Potentially suboptimal prescribing affected more than half the participating older Aboriginal Australians from the Kimberley. If generalisable to other remote Indigenous Australians, the prevalence of polypharmacy, potentially inappropriate prescribing, and under-prescribing of indicated medicines is problematic, and suggests that older Indigenous people in remote areas are at risk of medicine-related harm.

Delirium in the elderly. A survey of environmental policies and procedures in Melbourne hospitals.

This study aimed to review the presence of policies for management of behavioural symptoms and physical restraints, the availability of delirium management protocols and educational programs, and accessibility of a physical environment appropriate for the management of delirium in Melbourne hospitals. A structured survey tool was developed, and 70 Melbourne hospitals were surveyed seeking responses from a senior member of the nursing staff. Overall, 90% of Melbourne hospitals responded to the survey. It was found that smaller hospitals have fewer policies relating to the management of behavioural symptoms, and fewer delirium management protocols. Some education is available for nursing staff; however, less for the night staff, who often manage behavioural symptoms associated with delirium. Physical restraint policies exist at most hospitals. Single rooms and night lights are generally available, but low-low beds and orientation devices are relatively uncommon.