I am a general physician and clinical pharmacologist at Wellington Hospital. I spend about half of my time as a hospital clinical pharmacologist, trying to educate the most junior prescribers how not to harm patients with very potent drugs. Sometimes I am successful. I also educate the next generation of prescribers via my role as a senior lecturer at OUW.
In my role as a general physician I frequently see frail elderly patients admitted with a “geriatric syndrome”, and have spent much of the last couple of years trying to pick apart the evidence around whether we are curing/caring or killing our patients by treating frail elderly patients with treatment regimens tested on 50yos with single organ disease.
In my spare time I do some work for PHARMAC, the Medicines Adverse Reactions Committee of the Ministry of Health, and the Standing Committee on Clinical Trials.
Prescribing In The Frail – Less Is Best, But Choose Your Poison Wisely
Choosing Wisely is a global movement which aims to promote conversations between clinicians and patients by helping patients choose care that is “supported by evidence, free from harm & truly necessary”. In the frail elderly deciding what treatments meet that criteria is made more difficult by the lack of clinical trials performed which include patients from this demographic. In NZ, our unique population mix makes interpretation of any benefits seen in trials more complex.
In this presentation, prescription of common drugs in the frail elderly will be examined with attention to potential harms caused and how these can masquerade as “geriatric syndromes”. Potential benefits will be put under the microscope and presented as number needed to treat (NNT), to assist patients with decision making. This may open some eyes to the blind faith that we put into prescribing these drugs in our frail NZ elderly cohort.