Researcher spotlight
Professor Sarah Hilmer and her research team at the Kolling Institute are dedicated to improving life for older Australians. N orthern Sydney has one of the oldest populations in the country, making Professor Sarah Hilmer’s research pertinent as its positive impact can be felt right here in our community. Professor Hilmer’s ageing and pharmacology research group, based at the Kolling Institute, aims to improve healthy ageing in older people. A significant part of this focus is to ensure that medications are not adding to a person’s frailty, but instead, enhancing quality of life. “There is a great deal of complexity in understanding how to prescribe medication. We need to gain better predictions for how a drug will interact with everything about the patient: other medications and health conditions, diet, exercise, ethnicity, sex, age and frailty too.”
The challenge this provides is that it makes it very difficult to know the therapeutic effects and side effects of medications for each person, as these are so dependent on individual patient factors. Some of the side effects can be significant and end up making an ageing person look a lot older than they really are. In practice, it can be hard to distinguish these side effects from age itself or from the medical conditions that the medications were prescribed for. Professor Hilmer set out to identify whether different regimens of polypharmacy caused frailty and whether de-prescribing medication would reverse the negative effects of polypharmacy. In pre-clinical models, she and Dr John Mach, a basic science research fellow supported by the Penney Ageing Research Unit, were able to prove that some polypharmacy combinations impaired ageing. However, when the drugs were gradually ceased, the negative side effects disappeared too. This was a significant step in Professor Hilmer’s research and allowed her to move on to investigate a mechanism to understand how polypharmacy and the de-prescription of medications affected the body. Professor Hilmer developed the Drug Burden Index (DBI) as a solution to aid in accurately measuring the ways drugs could be slowing older people down both physically and mentally. This tool was developed to help clinicians understand the effects of the combination of medications better than just counting the number of medications, by also considering the type and dose of medications. The higher the DBI score, the higher the risk of medication-related impairment of cognitive and physical function.
It became clear early in my career that there was a big research gap when it came to understanding the ageing population. Professor Sarah Hilmer, Kolling Institute
One area that stood out to Professor Hilmer was the lack of knowledge of the effects of medicines in older people who have a lot of concurrent health conditions and take a lot of medications. Most medication is tested on people classified as middle aged and is not tested in combination with many other drugs. Polypharmacy is where five or more medications are taken by a single person. 43% of Australians over the age of 50 years old are taking five or more medications. This number increases to being two-thirds of Australians over 75. Combinations of drugs vary significantly between individuals, and it is simply not possible to test every combination of prescribed medications, with every combination of medical conditions and other patient factors.
With the help of pharmacist Dr Lisa Kouladjian O’Donnell, first as a National Health and Medical
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