Groundbreaking work in geriatric pharmacology
For the past 20 years, Professor Sarah Hilmer AM has dedicated her career to optimising medicine use for older people and has achieved recognition as a national and world leader in geriatric pharmacology.
Eager to put the DBI into clinical practice, Sarah and her colleagues developed a calculator that could measure a patient’s drug burden. They produced a way to integrate it into a hospital’s electronic medical record so that staff could use it when treating frail, elderly patients. In 2021 — at the height of the pandemic — Sarah ran a successful pilot study implementing the calculator at RNSH. “We managed to show that we could really improve prescribing,” she says. For the past 18 months, she and her team have run a clinical trial in three hospitals in Northern Sydney and three on the Central Coast to see if this package of tools can help clinicians to identify patients who are not functioning optimally because of the medication they have been taking and to minimise medication- related harm. The tools are now available for clinical care across Northern Sydney and Central Coast health districts and are being implemented at other NSW health districts. Sarah is eager to see the tool as part of routine hospital care. Nurses regularly have a “huddle” to discuss patient issues, which can include falls or delirium. Her team has been encouraging nurses to look at the Drug Burden Index during a huddle, and if it is high, arrange for a medication review. “It might be that the medication is causing the falls or confusion,” she says.
Not only has the Royal North Shore Hospital (RNSH) clinical pharmacologist and geriatrician set about improving medication practices for older people, but she has long advocated for ‘age-friendly’ clinical trials. One of Sarah’s notable contributions has been the development of the Drug Burden Index (DBI), a risk assessment tool that measures an older person’s exposure to medications that slow them down physically and mentally. “Over the past 20 years or so, we have been validating the tool in populations around the world to show that the higher your Drug Burden Index, the worse your physical function and your cognition is, and the more likely you are to fall or wind up in a nursing home,” she says.
Professor Sarah Hilmer
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Tomorrow’s medicine today
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