Onsite Pharmacists – Just What the Doctor Ordered

The Aged Care Onsite Pharmacist (ACOP) program aims to revolutionise medication delivery in residential facilities by placing trained professionals directly on-site.

Addressing Medication Mismanagement

The mismanagement of medications, inconsistent safety procedures, and low vaccination rates in aged care homes have long been controversial. Health authorities are urging providers to increase vaccine rates, as the lives of residents and communities are at risk. Despite these pleas, the Royal Australian College of General Practitioners reported that 97 aged care facilities had COVID-19 vaccination rates below 10%. Additionally, 706 facilities reported less than 50% of their residents vaccinated against COVID, with the lowest coverage in various states including New South Wales, Queensland, South Australia, Tasmania, Victoria, and Western Australia.

The Role of Onsite Pharmacists

The Aged Care Royal Commission identified medication delivery as a crucial area for improvement in aged care homes, recommending the employment of allied health practitioners, including pharmacists. Responding to this, the Federal Government has allocated $333.7 million to fund the ACOP program. This initiative enables residential aged care providers to engage pharmacists through local pharmacies or direct employment. These pharmacists will deliver personalised medications, manage frequent medication reviews, and administer antipsychotic drugs and vaccinations.

Goals of the ACOP Program

The ACOP aims to:

• Improve medication use and safety in aged care homes, particularly the use of high-risk medications.
• Ensure continuity in medication management through regular reviews and prompt issue resolution.
• Provide easy access to pharmaceutical advice for residents and staff.
• Integrate on-site pharmacists with the healthcare team, including local GPs, nurses, and community pharmacies.
• Enhance understanding and response to individual resident needs.

Support from the Pharmacy Guild of Australia

The initiative has garnered support from the Pharmacy Guild of Australia, recognising the potential to elevate the role of pharmacies. This program enables pharmacists not only to deliver medications and dose administration aids but also to provide quality use of medicines within the facility. A Pharmacy Guild spokesperson highlighted the additional services pharmacists can offer, such as vaccinations, as they begin to practice to their full scope. This will create further opportunities for community pharmacies to become significant providers of healthcare services to aged care facilities.

Funding Model

The ACOP funding model is divided into two tiers:

• Tier 1: Community pharmacies receive payments to engage with specific residential aged care facilities.
• Tier 2: Residential aged care facilities can claim up to $138,282 per year for the full-time equivalent employment of an on-site pharmacist.

This government-funded initiative promises to improve medication management and overall healthcare in aged care facilities, ensuring better health outcomes for residents.

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Alzheimer’s Discovery Holds Potential to Improve Drug Effectiveness

A groundbreaking discovery by Australian scientists could significantly enhance the effectiveness of drugs currently used to manage cognitive decline in Alzheimer’s disease patients. Alzheimer’s disease is the most prevalent form of dementia, which ranks as the second leading cause of death in Australia. An estimated 250 Australians are diagnosed with dementia every day.

The study, led by Australia’s national science agency, CSIRO, analysed data from 475 individuals with varying levels of cognitive impairment. Researchers focused on the presence of amyloid plaques in the brain, the atrophying or shrinking of the basal forebrain, and cognitive decline in terms of memory and attention.

Dr. Ying Xia, a researcher at CSIRO’s Australian e-Health Research Centre and lead author of the study, emphasised the importance of early diagnosis in managing Alzheimer’s disease symptoms. “Our results show how the atrophying of the basal forebrain, a key brain region for learning and memory and part of the cholinergic system, could indicate the presence of the disease well before symptoms occur,” Dr. Xia stated. “Our research suggests an important link between brain structure, in this case, shrinkage, and the way the brain functions during Alzheimer’s disease progression.”

These crucial findings could aid in the development of drugs designed to mitigate the decline in brain function observed in Alzheimer’s patients. This includes work with drugs currently undergoing regulatory approval, which clear amyloid plaques from the brain, potentially amplifying their cognitive effects.

Dr. Xia noted that while new drugs to clear amyloid plaques hold promise, it remains uncertain whether targeting these plaques addresses the underlying causes of memory and attention decline. “Currently, drugs available to manage cognitive decline in Alzheimer’s are only effective in up to 30 percent of cases,” said Dr. Xia. “We believe we can improve on that figure by increasing our understanding of the role played by the system targeted by current drug treatment regimes.”

The next phase of this research will involve identifying how early the impairment of the cholinergic system occurs and determining the optimal timing for administering cholinergic drug treatments to stabilise cognitive decline.

Published in Neurology, this study was a collaboration between CSIRO, the University of Queensland, Florey Institute, and the University of Melbourne. It utilized data from the Australian Imaging, Biomarkers and Lifestyle (AIBL) study, collected over more than a decade. AIBL involves comprehensive neuroimaging, biomarker, and neuropsychological assessments at 18-month intervals and is a consortium between Austin Health, CSIRO, Edith Cowan University, The Florey Institute, and the National Ageing Research Institute.

For dementia information and support, please contact the National Dementia Helpline at 1800 100 500. The National Dementia Helpline operates 24 hours a day, seven days a week, 365 days a year.

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Mental Well-Being Crucial for Healthy Aging, New Study Reveals

A recent study published in the journal Nature Human Behaviour has established the significant impact of mental well-being on healthy aging. The research evaluated the causal effects of mental well-being on genetically independent aging phenotypes (aging GIP), providing new insights into the relationship between mental health and aging.

Key Findings:

• Human Longevity and Challenges: While human life expectancy has increased over time, the aging population poses challenges for both individuals and society. Mental well-being is known to correlate with lifestyle behaviours and morbidity and is linked to physical health and increased survival.
• Socioeconomic Status (SES) Connection: Socioeconomic status (SES) is interlinked with both aging and mental well-being, but a direct causal relationship between mental well-being and healthy aging had yet to be established until now.

Study Overview:

Researchers utilised Mendelian randomisation (MR) to assess the effects of mental well-being on aging phenotypes. Summary-level genome-wide association study (GWAS) data from people of European descent were used. The exposures included various well-being traits such as life satisfaction, neuroticism, depressive symptoms, and positive affect. SES indicators—education, occupation, and income—were also considered.

A total of 106 candidate mediators were screened, including lifestyle factors, physical function traits, diseases, and behaviours. These mediators were selected based on their causal association with aging GIP and the well-being spectrum.

Methodology:

• Linkage Disequilibrium Score Regression: This was used to examine genetic correlations between mental well-being traits, aging phenotypes, and SES indicators.
• Univariable and Multivariable MR Analyses: These analyses were performed to assess the causal effects of mediators and mental well-being traits on aging phenotypes and to investigate the impact of SES indicators on mental well-being traits.
• Two-Step MR Analysis: This tested the mediating effects between the well-being spectrum and aging GIP.

Results:

• Genetic Correlations: Positive genetic correlations were observed between all mental well-being traits and aging GIP components (except for longevity). The well-being spectrum was linked to increased aging GIP, resilience, health span, parental lifespan, and self-rated health.
• Positive and Negative Associations: Positive affect and life satisfaction were positively associated with aging phenotypes, while depressive symptoms and neuroticism were inversely associated.
• SES and Well-Being: Higher income, education, and occupation were causally linked to improved mental well-being. The well-being spectrum independently correlated with higher aging GIP, even after adjusting for SES indicators.

Mediators:

Out of 106 candidate mediators, 33 met the criteria for inclusion. Key findings included:

• Unhealthier Lifestyle Factors: These were associated with lower aging GIP.
• Positive Influences: Factors such as later smoking initiation age, higher cheese consumption, appendicular lean mass (ALM), cognitive performance, high-density lipoprotein cholesterol (HDL-C), and fresh fruit intake were associated with higher aging GIP.
• Significant Diseases: Heart failure, hypertension, stroke, and coronary heart disease had the highest effect sizes on aging GIP.

Several factors, including antihypertensive medication, smoking initiation age, and television watching time, mediated at least 7% of the effect of the well-being spectrum on aging GIP. Other mediators, such as non-steroidal anti-inflammatory drugs, waist-to-hip ratio, and fresh fruit intake, also played significant roles.

Conclusion

The study illustrated the causal effects of mental well-being on aging phenotypes independent of SES. Better mental well-being was linked to improved aging GIP, with the causal effect partly explained by various mediators, including lifestyle factors, physical functions, diseases, and behaviours. These findings underscore the importance of prioritising mental well-being to promote healthy aging.

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