Antimicrobial use in aged care homes identified as a ‘key issue’
A recent report into the antimicrobial use and antimicrobial resistance in Australia has once again highlighted that aged care homes are among one of the most at risk areas for overprescribing and resistance.
The use of antimicrobials in aged care is an issue for consideration in prescribing practice (Source: Shutterstock)
The 2017 Antimicrobial Use and Resistance in Australia (AURA) Surveillance System report released by the Australian Commission on Safety and Quality in Healthcare, and the 2017 Aged Care National Antimicrobial Prescribing Survey, note that ‘key issues that can promote antimicrobial resistance were identified.’
Spokesperson for the Australian Commission on Safety and Quality in Health Care says that the results are raising concerns.
“Given the findings of the AURA Surveillance System, the use of antimicrobials in aged care is an issue for consideration in prescribing practice,” the spokesperson says.
“Residents in aged care homes may have multiple medical problems, and are frequently admitted to hospital.
“This increases the risk of these vulnerable people acquiring antibiotic-resistant infections, or of developing medical complications.
“Patients may also acquire resistant germs in hospitals, or in their aged care home and take them to hospital, where they can spread to other vulnerable patients.”
The report states in a number of instances that the rates of resistance to antimicrobials were ‘lower in the community for most agents where data were available, than in hospitals’ also stating that ‘rates in aged care homes were often as high, or higher, than in hospitals’.
The Australian Commission on Safety and Quality in Health Care spokesperson says that this is a cause for concern in itself.
“All antimicrobial use can lead to antimicrobial resistance,” the spokesperson says.
“Elderly patients are at increased risk of infection, and are at high risk of getting antimicrobial resistant infections.
“More than two-thirds of the results submitted to the Critical Antimicrobial Resistances (CARAlert) surveillance system for critical antimicrobial resistances, in the twelve months to March 2017, were in patients older than 60 years.”
Director of Clinical Excellence for Ward Medication Management Dr Chris Alderman has also spoken out on the topic, saying that “there has been evidence that sometimes we go in too hard with prescribing for older people in aged care”.
“There can of course be pockets of over-prescribing around,” he says. “But no doctors go out and want to prescribe lots of drugs to people for no reason – it’s not something that is done without reason.
“It is important to note that when it comes to older people, signs and symptoms can be different and the stakes are a lot higher.
“In saying that there are situations where it could be wise to hold off.”
Dr Alderman says that there is a difference in prescribing for young and old, especially when taking into account an elderly patients medical history.
“With younger people we can often hold off but with older people, especially with history of respiratory issues and the like, they are more at risk,” he says.
“So if we are looking at treating a sore throat in an older person, we may treat it differently so that it doesn’t develop into an upper or lower respiratory infection or pneumonia resulting in hospitalisation and possibly more detrimental outcomes.
“With older people it’s worth doing, or the costs can be very high indeed.”
Despite his mention of the risks involved with not prescribing sooner rather than later with older Australians, Dr Alderman says that medications don’t come without their risks.
“There are all kinds of risks associated with medication use – any medication comes at a variety of costs,” he says.
“Medications can cause side effects, mix with other medications – this is why it is important to not prescribe if it is not needed.
“It is not necessary if the prescription is creating these risks for no benefit.”
Spokesperson for the Australian Commission on Safety and Quality in Health Care also reiterates the risks associated with over prescribing of antimicrobials stating that it can cause:
- Development of resistance
- Risk of medication side-effects in frail and elderly patients
- Infection with other resistant organisms (e.g. Clostridium difficile diarrhoea)
- Transmission of resistance to other vulnerable people in aged care homes, or if residents are transferred to hospital
For anyone who is concerned about their own medications or those of family or friends, Dr Alderman recommends speaking to your local General Practitioner or pharmacist as a starting point.
