The Aged Care On-site Pharmacist (ACOP): a new initiative in residential aged care in Australia

In Australia, residential aged care homes (RACHs; also known internationally as long-term or nursing home care) provide permanent or temporary accommodation and support for older individuals who can no longer live independently [1]. There are ~190 000 people permanently living in Australian RACHs with 59% aged 85 years and above [2]. Age-related changes in drug response and the high rates of frailty and multimorbidity (≥2 chronic conditions) in aged care residents contribute to the complexity of pharmacotherapy and heighten the risk of both under- and over-prescribing in this population [3]. Prevalence of polypharmacy and hyper-polypharmacy (co-prescription of ≥5 or ≥10 medications, respectively) in Australian RACHs is high, affecting up to 95% and 25%, respectively, and increases with age, higher care needs and longer stay [3]. Over half of the residents are prescribed potentially inappropriate medications, incurring financial and clinical consequences (e.g. higher total medication costs, delirium, falls, hospitalizations and premature mortality) [3, 4]. Alarmingly, 20% of residents experience an adverse medication event each month, with over 80% of these deemed potentially preventable [5].