Potentially Inappropriate Medication at a Private Hospital

Potentially Inappropriate Medication at a Private Hospital Abstract The use of certain medications in geriatrics when potential risks outweigh the potential benefit and an effective alternative is available is called as Potentially Inappropriate medication. Because geriatrics are more sensitive towards adverse effects of medications. Beers criteria which is updated and reviewed by American Geriatric society list out 53 medications/therapeutic classes of drugs to be avoided in geriatrics. Methodology: A prospective observational study was conducted for 9 months in a 650 bed private corporate hospital, South India. All geriatric patients admitted in the hospital during the study period was included. Beers Criteria 2013 were used to identify potentially inappropriate medications. Result: The prevalence of PIM use (52%) was significantly higher in study population. An avg of 10 drugs were taken by the study population. A total of 215 medications were identified as PIMs. Among them 195(90%) medications should be avoided by the geriatrics independent of th eir condition (category I). 66(60%) of the study population had used more than one PIMs. 91(83%) of the PIM users had atleast one DRPs and the mean DRPs value of the PIM users were 1.59à ¯Ã¢â‚¬Å¡Ã‚ ±1.3. Conclusion: High prevalence of PIMs in the study population signifies the need of monitoring geriatric prescriptions. Key words: PIMs, Beers Criteria, Geriatrics Introduction In recent years proportion of geriatric hospital admission with comorbidity and polypharmacy has been increasing continuously (1, 2). Adverse drug events (ADRs) are the most common reason for hospital admission, but sometimes it’s not identified. Medication errors (MEs) or conventional adverse drug reactions (ADRs) are the common reason for adverse drug events which ends in clinical symptoms. Overall, elderly patients need greater attention to drug therapy and safety parameters (1, 3-5). Greater attention is needed for geriatric population due to age related pharmacodynamics and pharmacokinetic changes. But appropriate pharmaceutical care for elderly are determined on the basis of clinical trial conducted with adult population.(6) The burden of harm resulting due to the use of multiple drugs in geriatric populations is a major health related problem in developed countries. A research study reveals that around one in four geriatrics admitted to hospitals are prescribed with at least one inappropriate medication and potentially preventable adverse drug reactions accounts for nearly 20% of all inpatient deaths (7). The assessment of potentially inappropriate medication (PIM) in geriatric is a challenging work and there is a need for considering many factors which influences the prescribing as well as outcome. Eight well known tools are available to identify the PIMs and studies reports that Beers criteria is the best and easy one to assess the PIMs. Beers criteria also has the advantage over others because it is periodically updated (8).This study therefore aimed to investigate the prevalence of PIM use on geriatric population using Beers criteria 2012 and its association with Drug Related Problems (DRPs) . Methodology Study Site: The work entitled â€Å"A study on prevalence and impact of Potentially Inappropriate Medication use in geriatrics at a private corporate hospital† was carried out in a 640 bedded private corporate hospital, South India. Study Design: Prospective –Observational study. Study Period: Nine months. Inclusion criteria: Patients above age of 65 yrs. Exclusion criteria: The patients who are unwilling to participate in the study and out patients METHOD: A regular ward rounds was carried out in all the wards of General medicine. Each patient’s medication profile was reviewed. Patients who met the inclusion criteria were briefed on the project with the help of patient information form and if they are willing to participate in the study their consent was obtained. The data from medical chart were recorded in customized data entry form. The prescribed drugs were evaluated and PIMs use were identified with the help of Beer’s criteria. The drugs which are identified as PIM are categorized into following: Potentially inappropriate medications /classes to avoid in geriatrics, Potentially inappropriate medications /classes to avoid in geriatrics with certain pathological condition that the listed PIM use can exacerbate Medications to be used with caution in geriatrics. ADRs associated with PIMs use were assessed. Drug interaction and ADR was monitored and reported. DRPs and Drug Risk Ratio (DRR) were calculated for PIMs. DRPs were the sum of ADR, drug interaction and drug allergy.DRR was calculated as the number of DRPs in relation to how often the drug was used (DRPS/number of times used). Results and Discussion In the study period, 212 patients were included in the study as per inclusion criteria and exclusion criteria. 110 (52%) patients were found to be prescribed with PIMs listed in Beers criteria (fig no: 01). A similar study conducted by Birader K et al (2013) (9) reported that PIM prevalence were 38% in their study population. Increased anxiolytics use as a prophylaxis for hospital related anxiety might be the reason for high prevalence of PIM than the later study. The total number of patients in study population were 110. Among them 62(56%) were males and 48(44%) were females.The study result reveals that PIMs user are mostly males. A similar study conducted by Birader K et al (2012) (9) reported that prevalence of PIM use is more among males than females. The age categorization of PIM users was done. The maximum age of PIM users was 93 years and mean age of PIM users was found to be 70.2 ±5.77. The median age for PIM users was 68.5 years. The result indicated that age group of (65-69) were commonly prescribed by PIMs. This results compared with a previous study carried out by Birader K et al (2012) (9) which also reports that PIMs were frequently prescribed in the age group of 65-69 years. The social habit of the PIM users shows that 8(7%) patients were smokers and alcoholics, 14(13%) patients were alcoholics, 21(19%) patients were smokers and 67(61%) patients were teetotalers in PIM users. The comorbidities of the PIM users was analyzed. There were 52 (47%) suffering from hypertension and 32(29%) were suffering from DM. The results shows that most of the study group had comorbidities of hypertension followed by DM and CVDs. A similar study conducted by Fouquet A (11) also reported that most common diagnosis among their study population was hypertension and diabetes. The number of drugs prescribed for the PIM users were calculated (fig no: 2). The mean number of drugs per prescription was 9.9 ±2 with the maximum of 16 drugs and minimum of 5 drugs prescribed. The above results signifies that all prescriptions were in polypharmacy category. A similar study conducted by Blozik E (12) concluded that one of the main factor for PIM use is â€Å"polypharmacy†. The number of PIM drugs per prescription in the study population was calculated (Fig no: 3). The result reveals that 44(40%) were using one PIM drug, 50(45%) were using two PIMs, 14(13) were using three PIMs, 1(1%) were using 4 PIMs and the maximum of 5 PIMs use were found in 1(1%) of the study population. 66(60%) of the study population consumed more than one PIM. The mean was found to be 1.8 ±0.78 and an avg of 2 PIM was used by the study population. A similar study conducted by Dormann H (2013) (13) were reported that 87% of the study population consumed at least one PIM. Among the PIM users the total number of PIM drugs was calculated and it was found to be 215 drugs. PIM users were categorized into three groups according to Beers criteria. (Table no: 2) There were 195(90%) belongs to category I, 12(6%) were in category II and 8(4%) were in category III. The individual categories of PIM was analyzed. It was found that alprazolam 57(52%), clonazepam 17(15%), hyocyamine 10(9%), Lorazepam 10(9%), hydroxyzine 10(9%), zolpidem 10(9%), ketorolac 10(8%) were prescribed in category I (table no: 3). A similar study conducted by Birader K et al (2013) (16) reported that alprazolam and cimetidine were frequently used PIM among their study population. Use of hyocyamine in constipation 3(25%) accounts for the most frequent inappropriate drug use in category II (table no: 4). Hydroxyzine in constipation 2(17%), cyproheptidine in constipation 2(17%), ketorolac in PUD 2(17%), clonazepam in frequent fall 1(8%), ketorolac in CHF 1(8%) and theophylline in insomnia 1(8%) were other category II inappropriate medication use. Use of escitalapram 3(40%), mirtazapine 2(30%), fluoxetine 1(10%), sertraline 1(10%) and Duloxetine 1(10%) were the category III PIMs (table no:5). The DRP among the PIM users were analyzed (fig no: . It was found that 19(17%) of the PIM users were free from DRPs. Majority of the study population had at least one drug related problems. The mean value of DRP in the study population was found to be 1.59 ±1.3. The minimum observed number of DRP per patient was one and maximum observed number of DRP per patient was six. The ADR use was monitored in the study population. A total number of 40 ADR associated with PIM use (Fig no:5) and 14 ADR associated with nonPIM use were identified. The study result reveals that one among three PIM users were found to have at least one ADR. A similar study conducted by N. Nixdorff et al (2008) were also reported that PIM users were found to experience ADR most frequently than nonPIM users. As a part of our study, screening of drug interactions were done. A total number of 131 major drug interactions were identified, in that 111 were unique. Among the drug interactions found 16(12%) were PIM-PIM drug interactions, 39(30%) were PIM-other drugs drug interactions and 76(58%) were caused by non PIM drugs (table no: 6). Drug risk ratio were calculated for the study population (table no:7). It was observed that prochlorperazine had the highest DRR (4) followed by phenobarbitone (2), digoxine (2), pentazocine (2) and duloxetine (2). The statistical analysis of obtained results has been done using statistical tools. The association of different variables are analyzed using à ¯Ã‚ Ã‚ £2 test. On assessment of association between â€Å"number of comorbidities† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:8), the result proved that â€Å"number of comorbidies† are statistically associated with â€Å"the number of drugs† at 0.001 level of significance and â€Å"number of PIMs† at 0.05 level of significance. It means that as number of comorbidity increases polypharmac and PIM use also increases. On assessment of association between â€Å"number of drugs† and â€Å"number of PIMs† (table no: 9), the result proved that â€Å"number of drugs† are statistically associated with â€Å"number of PIMs† at 0.05 level of significance. This result proves that polypharmacy is one of the reason for PIMs. On assessment of association between â€Å"number of DRPs† with â€Å"number of drugs† and â€Å"number of PIMs† (table no:10), the result proved that â€Å"DRPs† are statistically associated with â€Å"number of PIMs† at 0.01 level of significance but not associated with â€Å"number of drugs† at 0.05 level of significance. This result proves that DRPs is more associated with PIMs than polypharmacy which means it not the number of drugs contributing to DRPs but the use of PIMs. Conclusion Our study identified a high prevalence of PIMs use and associated DRPs in the study population. DRPs due to PIMs is preventable. Development and implementation of new criteria or modification of already existing criteria such as Beers criteria, START STOPP criteria which will helps in safe prescribing practice can reduce the PIMs use. References Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med 2011; 365: 2002–12. Budnitz DS, Shehab N, Kegler SR, Richards CL: Medication use leading to emergency department visits for adverse drug events in older adults. Ann Intern Med 2007; 147: 755–65. Lau DT, Kasper JD, Potter DE, Lyles A, Bennett RG: Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005; 165: 68–74. Pirmohamed M, James S, Meakin S. Adverse drug reactions as cause of admission to hospital: prospective analysis of 18 820 patients. BMJ 2004; 329: 15–9. Chrischilles EA, VanGilder R, Wright K, Kelly M, Wallace RB. Inappropriate medication use as a risk factor for self-reported adverse drug effects in older adults. J Am Geriatr Soc 2009; 57: 000–6 Avorn J, Shrank WH. Adverse drug reactions in elderly people: A substantial cause of preventable illness. BMJ. 2008;336:956–7 Minimizing Inappropriate Medications in Older Populations: A 10-step Conceptual Framework. Ian A. Scott, MBBS, MHA, MEd,a Leonard C. Gray, MBBS, MMed, PhD,b Jennifer H. Martin, MBChB, MA (Oxon), PhD,c Charles A. Mitchell, MBBSd Opondo D. Inappropriateness of Medicationth Prescriptions to Elderly Patients in the Primary Care Setting: A Systematic Review, plos one, aug 2012, volume 7, issue 8 Biradar K; assessment of potentially inappropriate medication in elderly patients at Basavehwar teaching hospital;IJPP 2012dec, vol 5,issue 4, 73-5 Denys TL (2011) Functional Decline Associated With Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults With Dementia, Am J Alzheimers Dis Other Demen. 2011 December ; 26(8): 606–15. doi:10.1177/1533317511432734 Fouquet A, Zegbeh H, Krolak-Salmon P, Mouchoux C. Detection of potentially inappropriate medication in a French geriatric teaching hospital: A comparison study of the French Beers criteria and the improved prescribing in the elderly tool. J Eurger 2012 3: 326-29 Blozik E, Rapold R, von Overbeck J, Reich O. Polypharmacy and potentially inappropriate medication in the adult, community-dwelling population in Switzerland. Drugs aging. 2013;30:561-8 Dormann H, Sonst A, Mà ¼ller F, Vogler R, Patapovas A, Pfistermeister B, Plank-Kiegele B, Kirchner M, Hartmann N, Bà ¼rkle T, Maas R. Adverse drug events in older patients admitted as an emergency the role of potentially inappropriate medication in elderly people (PRISCUS). Dtsch Arztebl Int 2013; 110(13): 213–9. DOI: 10.3238/arztebl.2013.0213 N. Nixdorff et al. Potentially inappropriate medications and adverse drug effects in elders in the ED. AJEM 2008 26: 697–700 Tables and figures NO. of PIM/prescription Number of patients N=110 Percentage 1 44 40 2 50 45 3 14 13 4 1 1 5 1 1 Table no:1 Number of PIM per Prescription sl no category no. of PIMs percentage 1 PIM drugs/classes to be avoid in geriatrics (category I) 195 90 2 PIM to be avoided in certain pathological condition (category II) 12 6 3 PIMs to be used with caution (category III) 8 4 Table no:2 Categories of PIM sl no Drugs No. of Patients sl no Drug No. of Patients 1 Alprazolam 57 (29%) 16 Nitrofurentoin 3(1.5%) 2 Clonazepam 17(9%) 17 Mirtazapine 2(1%) 3 Hyocyamine 10(5%) 18 Cyproheptidine 2(1%) 4 Lorazepam 10(5%) 19 Diazepam 2(1%) 5 Hydroxyzine 10(5%) 20 Piroxicam 2(1%) 6 Zolpidem 10(5%) 21 Prochloperazine 2(1%) 7 Ketorolac 10(5%) 22 Chlorphemiramine 2(1%) 8 Aceclofenac 9(4.5%) 23 Trihexylphenedine 2(1%) 9 Propoxyphene 8(4%) 24 Digoxin 2(1%) 10 Diclofenac 7(3.5%) 25 Phenobarbitone 1(0.5%) 11 Spironolactone 6(3%) 26 Naproxen 1(0.5%) 12 Prazosin 5(3%) 27 Clinidium-chlordiazepoxide 1(0.5%) 13 Clonidine 5(3%) 28 Indomethacin 1(0.5%) 14 Chlordiazepoxide 3(1.5%) 29 Metachlopramide 1(0.5%) 15 Amitriptyline 3(1.5%) 30 Pheniramine 1(0.5%) 31 Pentazocine 1(0.5%) Table no: 3 Category 1(PIM drugs/classes to be avoid in geriatrics) Sl no Drug Disease No. Patients Percentage 1 Ketorolac CHF 1 8 2 Hydroxyzine Constipation 2 17 3 Hyocyamine Constipation 3 25 4 Ketorolac PUD 2 17 5 Cyproheptidine Constipation 2 17 6 Clonazepam Frequent Fall 1 8 7 Insomnia Theophyllin 1 8 Table no: 4 Category II (PIM to be avoided in certain pathological condition) sl no Drug No of Patients percentage 1 Mirtazapine 2 30 2 Fluoxetine 1 10 3 Sertraline 1 10 4 Duloxetine 1 10 5 Escitalapram 3 40 Table no: 5 Cateegory III (PIMs to be used with caution) NO OF INTERACTION PERCENTAGE PIM-PIM 16 12 PIM- OTHER DRUGS 39 30 OTHER DRUGS 76 58 Table no:6 Categories of Drug Interactions Sl No Drug DRPs Total Drug Risk Ratio 1 PROCLORPERAZINE 8 2 4.00 2 PHENOBARBITONE 2 1 2.00 3 DIGOXIN 4 2 2.00 4 PENTAZOCINE 2 1 2.00 5 DULOXETINE 2 1 2.00 6 NAPROXEN 2 1 2.00 Table no.7 Drug Risk Ratio Sl no Varience No. of comorbidities Chi squire value P value 1 2 ≠¥ 3 1 No. of PIMs 1 5 21 13 12.76* 0.05 2 10 12 15 ≠¥ 3 7 15 12 2 No. of drugs 6-8 13 16 4 26.77* 0.001 9-11 8 25 17 ≠¥ 12 1 7 19 Table no:8 Association of no. of comorbidities with no. of drugs and PIMs . varience No. of Drugs Chi squire value P value 6-8 9-11 12-14 ≠¥15 No. of PIMs 1 16 21 4 3 21.76* 0.001 2 14 24 8 4 ≠¥ 3 2 5 5 4 Table no: 9 Association of no. drugs and no. PIMs Sl no Varience No. of DRPs Chi squire value P value 0 1 2 ≠¥3 1 No. of PIMs 1 11 21 10 2 21.76* 0.001 2 7 23 8 12 ≠¥ 3 1 4 2 9 2 No. of drugs 6-8 9 15 11 1 11.77 0.05 9-11 4 25 6 12 ≠¥ 12 6 8 3 10 Table no:10 Association of DRPs with no. of drugs and PIMs Fig no:1 Prevalence of PIMs Fig no:2 Number of Drugs Prescribed per Patient Fig no:3 Number of PIM per Prescription Fig no: 4 Adverse Drug Events and Its frequency Fig no:5 Adverse Drug Events and Its Frequency

Demand and Supply of Housing in Australia

Economic Policy Problem: Demand and Supply The demand and supply of Housing and the Housing affordability in Australia I. Introduction Like all other economies The Australian economy has been affected by the global financial crisis which is now a global economic crisis due the collapse of Lehman Brothers and other financial institutions in US. The consequences of the global economic crisis has been severe and as a result of this the world is in Recession therefore many economies has pushed the budget into a deficit launching economic package trying to boost their economies.Because the housing market and the housing industry is one of the most important sector of the economy this report aim to analyse how the global financial crisis has affected the demand and supply of housing in Australia also what are the condition of housing affordability and how the Government through the stimulus package tend to intervene the economy.After this report we will be able to understand the movement a nd the reason for a movement into the demand and supply curve for housing in Australia you will be able also to identify if the Government economic policy is going for the correct pathway or if this temporary measure will not bring certainty and confident to the economy. It is very clear that at least the Rudd’s Government is addressing the problem anticipating future scenarios and acting to correct this scenarios exploiting and taking advantage of the relative good shape of the Australian economy in this moment in comparison with another countries.II. Australian Economy Like all other economies the Australian economy was very much affected by the global economic crisis and the recession around the world therefore the financial institutions started to feel the pressure and the stress of the situation but the Australian Government put in place measures to guarantee the debts of banks. Apart of that the Australian economy was affected by the collapse of commodity prices this br ought real losses of income to the economy which put to business in a position to review their investment plan in the future.At the same time households have become more cautious about expenditure due the increase of the unemployment rates and they start to increasing savings. Because the panic caused and the lack of consuming the RBA responded lowering of interest rates reducing from 7 ? per cent to 3 ? per cent, this reduction have fully passed to the borrowers therefore interest rates on housing loans have fallen as well as interest in consumer and business loan, this rate are at historically low levels.This has produced an increase in loan demand; other factor that increased the demand of loans apart of the lowest interest rate around 5 ? per cent is the program first home owner grant which has attracted new buyers into the market. On top of that the stimulus package is an initiative of the government to support spending but this measure cost that last financial year there was f iscal surplus of 1 ? per cent of the GPD even so Australia will remain as one of the better performing economies around the world.One of the reason of the reduction in wealth over the past year is that people which income have grown over the year overestimated the returns of the share market, people did not set up realistic expectations about their financial goals and now they have to increase the proportion of income working additional year or many of them returning to the workforce to compensated the losses of the share market due the global financial crisis, people did not took in count that share market produce negative returns every few years therefore they should have included this into the returns expectations.Although the large fall in wealth the households sector still is in a relative good position because people is maintaining a good balance between assets and liability and even when the hose market was subdued during 2008 and the prices has fallen by 3 per cent, the Aust ralian overall the housing market has held up pretty well in comparison with another countries like US or UK where price has fallen by 20 per cent. An update on the economy and financial Developments (Battellino, 2009) III. Supply and DemandThe relatively high level of housing price in Australia is a reflection of a collective decisions of households, this is not the result of a external forces they are at their income, preferences, access to finance have been willing to pay those prices. But this is not the only reason the supply – side factors also influenced in the fact of high price like the ability to built new housing on the city fringe, factor affecting the ability to increase supply closer to the city, transport infrastructure and community affect the feasibility and desirability of living in a different place.One of the good indicators of some of the supply issue is the cost of raw land. Prices still are high on the edges of Sydney but lowest on Melbourne and Adelaid e therefore will very important to see if it is possible to reduce these prices or at least try to keep a lid on increase over the years because the housing affordability over the medium term will be the result of the ability to expand the supply of housing.Home building has recently been at low levels and this is because in a showing or uncertainty situation economy builder does not want to take higher risk than usual and also recent weakness in building approvals are affecting the supply curve and when there is a lack of supply and increase in demand the prices will go upwards. Conditions and Prospects in the Housing Sector (Richards, 2009)Looking beyond that the fall in interest rate and improvements in housing affordability should contribute to growth this has not happened but economist are expecting that occurred during this year and gradually boost home-building. Another factor that can contribute the building approval for building activities and therefore increase the supply of housing is the increase of number of first – home buyer demand there has been an important increase in loans approval in recent months.Is also very important understand that for many economist in this moment there is undersupply in the housing market even though we do not know exactly how large the undersupply it is but this should support also home-building. According with the current population rates, the decline in average household and level of demand for second house had been maintained most calculation now put â€Å"underlying demand† around 180. 000 to 200. 000 per year that means we need to increase the number of new house built than has actually occurred.However, we can ignore the impact of prices on the demand for housing remember over the years the cost of housing has grown faster than incomes and the cost of goods and services as a consequence of that the demand for housing will be affected by the higher cost of housing therefore we can expect that the d emand decline because many young adult will choose to live with their parents for longer, many other would prefer extra flatmate rather than having a bedroom vacant and another owner of holidays homes very likely to sell them so perhaps this is the reason that we have built fewer homes in recent years than might have been expected.But the undersupply of housing is a story of never ending because there is an Intelligent Housing Research Group â€Å"Hometrack† stated that the calculation of the RBA are based in accurate data according with them Australia may already have an excess of housing according with their estimation there are at least 10 millions dwellings in Australia compared with the 8. 3 millions of ABS data showing occupied dwellings of 8. millions, the extra two millions are housing awaiting to be sale or development, second homes and abandoned homes. Therefore they say that the ABS Method for calculation the ratio of people per dwelling per dwelling is based on AB S census data which is based upon occupied dwelling however Hometrack analysis is based on postal address indicates that Australia’s current level of housing relative to its population is in line with other Anglo economies.Following this looking at the context of population growth Australia total building approvals have running about the demand, for that reason the concern is that business and government decision in regards of housing market are being made based on demand assumptions that vary from the actual behaviour of the housing market. But how can we know who is telling the true well according with statistics during 1985-2009 an average of 1 residential dwelling was built per 1. 75 new Australian and only in the last 3 months has the rate of new building fallen behind population growth.This is in excess of the current ABS ratio of 2. 55 person per occupied therefore far from having and undersupply of housing Australia may well have substantial oversupply, it’s ju st that no-one is living in many of them. Is very likely cause of this large stock of unoccupied homes is Australia system of negative gearing. Most investor prefer build houses but avoid the renting-damage property having to manage tenant therefore they built it for capital gains because is better to keep the hose out of the rental market and claim the loss against tax.In order to defend the dominant view that Australian house price are justified by supply and demand, Anthony Richards (Economist) observed that the relative high level of housing price in Australia is a reflection of demand and the collective decision of households therefore housing price have not been set by external forces they are at this level because buyers in general have been willing to pay the prices. This is a fairly typical piece of neoclassical economic thinking â€Å"Prices reflect the interaction of supply and demand and are therefore justified†.Economist who apply a standard â€Å"Supply and dem and† mindset to analysing the property market seem to consider that demand can shift â€Å"Left and right† as the number of buyers falls and rises with time; but they seem to ignore that the demand curve can shift up and down as well. Is response to the willingness of lenders to increase or decrease their loan to valuation ratios and if there is a substantial fall in LVR to new buyers could reduce the price that would be buyers can offer even in shortage of properties.Price S D3 D2 D1 Quantity of Supply, Demand Increase of demand due to: †¢ Population Growth †¢ Low interest Rates †¢ Booming economy with rising wages †¢ Governments Policies like Cuts to capital gains taxes Lies, damned lies, and Housing statistics (Keen, 2009) Bentick, Teresita, (2003) Microeconomics Study guide (4th Ed). Australia: Pearson Educations Australia. Frank, Robert, Bernanke Ben, (2001) Principles of Microeconomics (1st Ed).New York, USA: McGraw Hill Higher Education IV. Ho using Affordability. Housing affordability can be divided in two: people need where to live whether they buy or rent therefore we need to include rents as well as mortgage to measure housing affordability, the second part is people who are looking to get into the housing market and people who already are already there. Housing affordability is consider as spending up to 30% a household’s income on mortgage repayments or rent.In the past two decades the prices of the housing has risen matched by a decrease in housing affordability this mean that a household now need 34. 8% of their income to meet an average loan repayment. According with a report released entitled â€Å"Anatomy of Australian Mortgage Stress† released by fujitsu consulting in April found that the main cause of mortgage stress is the interest rate rises and rents have risen slower than mortgage repayments pushing people out the house market and into the rental market, this mean that rents too are on the r ise.According with report released by The Real State Institute of Australia REIA on April 22th 2009 â€Å"An opportune time for renters to buy† the ABS released the Consumer Price Index (CPI) showing that housing components increased 0,9% for the quarter bringing the annual increase to 5. 5%. The majority of this increase in the housing components was driven by rents which increased by 1. 7% over the quarter and 8. 4% over the year, this ncrease in rents reflects record low vacancy rates and the unavailability of rental properties in all capital cities. Building approvals and housing finance for investment purposes continue decrease during the March quarter 2009 and is very likely to put further upwards pressure on rents. Australia will need to build significantly more house than has occurred recently to meet rental demand. Housing affordability has improved significantly since the reserve bank began cutting interest rates in September 2008.With the availability of the first home owners boost (FHOB), lower interest rate, greater affordability and vacancy rates remaining in a low record now would be an opportune time for these in the rental market to consider the purchase of their own home. Real Estate institute of Australia (2009, April 22). Ann opportune time for renters to buy. Retrieved April 28, 2009, from http://www. reia. com. au/media/documents/REIA_MediaRelease_AnOpportuneTimeforRenterstoBuy. pdf Housing costs and Affordability in Australia (Thrift, 2008) ConclusionIs very clear that the housing sector in Australia is showing signs of improvements due the increase in households cash flows as a result of the of the important role of the Government and the RBA in the downturn of the economy decreasing the interest rates and providing policies that improve housing affordability for people to repay the loans but in order to tackle this important problem is very important that the government does not exclude anyone from the spectrum like young people also is very important that the Reserve Bank of Australia as a Central bank play an important role n this matter acting more like an honest broker developing real strong statistic about the housing market that helps in a future time to provide valuable resources, accurate data and support important decisions about the supply and demand of housing market instead of take part of this problem assuming neoclassical position taking in consideration on side of the problem and ignoring the other.REFERENCE LIST ? Bentick, T. (2003). Microeconomics Study Guide. Pearson education Australia, Australia: Pearson Education Australia Frank, R. , Bernanke B. (2001) Principles of microeconomics. Mc graw Hill, New York: Gary Burke ? Thrift Rhea, (2008) Housing and Affordability in Australia . Retrieved April 27, 2009, from http://www. rba. gov. au/EconomicsCompetition/2008/Pdf/2008_first_year. pdf ? Real Estate institute of Australia, (2009, April 22). Ann opportune time for renters to buy. Retrieve d April 28, 2009, from http://www. reia. com. au/media/documents/REIA_MediaRelease_AnOpportuneTimeforRenterstoBuy. pdf ? Battellino, Ric. 2009, March 31). An Update on the Economy and Financial Developments. Retrieved April 27, 2009, from http://www. rba. gov. au/Speeches/2009/sp_dg_310309. html ? Richards, A. (2009, March 26). Conditions and Prospects in the Housing Sector. Retrieved April 27, 2009, from http://www. rba. gov. au/Speeches/2009/sp_dg_310309. html ? Keen, S. (2009, April 08). Lies, damned lies, and housing statistics. Retrieved April 27, 2009, from http://www. businessspectator. com. au/bs. nsf/Article/Lies-damned-lies-and-housi

The Unusual Secret of Gmat Argumentative Essay Samples

The Unusual Secret of Gmat Argumentative Essay Samples When you purchase an argumentative essay from Ultius, you may rest assured our expert writers will do anything it requires to guarantee the sample order is 100% correct before you login and download this, and if your criteria has changed, no issue, totally free revisions are included with each purchase. After you've decided on a subject, think about the advantages and disadvantages of the problem. Moreover, our English-speaking writers make sure every order has original content and a suitable structure. A controversial issue is going to have nearly equal quantity of folks supporting the issue as the opposition. For instance, you ought to keep the readers in mind as you select arguments to strengthen your position. When choosing an issue to argue, you should select a topic that has more than 1 side. Though the response may start to deal with the assigned task, it provides no development. Our convenient and confidential message process is right here in order to assist you. Where to Find Gmat Argumentative Essay Samples Buy argumentative essays from us and find the very best part of study that you deserve from a trustworthy essay writing service. If you understand what you will create GMAT essay, be sure you search the world wide web and read more books. If you get a very clear essay, readers will understand easily what you would like to tell. Nowadays it is extremely difficult to locate a trustworthy essay writing service. For instance, a PDF file is going to be noted PDF in the search engine. There's several essays completed by them. Whenever you aren't exactly certain how to compose an argument essay, you ought to get a great sample paper because it is going to end up being a valuable resource that enable you to finish the assignment effectively. There are numerous argument essays on such sites. Custom against the death penalty papers, a succinct murder isn't right, the third objection against capital punishment is that it's always possible an inmate. For instance, there isn't any way you may argue on the subject of whether humans walk on two legs because it is a known fact with no attached debate. When you drop an argument, it is likely that you only used opinion to back up your position. You'll certainly lose the argument if nobody wishes to read your essay. The Hidden Gem of Gmat Argumentative Essay Samples Bridget's essay is extremely strong, but there continue to be a couple little thing s that could be made better. Becoming in a position to argue in a logical and reasonable manner is an excellent life skill. The net has made our life a good deal simpler. When it's your time to compose argumentative essay, you came to the correct spot. Gmat Argumentative Essay Samples Ideas It's fine to jot down simple thoughts and sentence fragments. Writing has existed for quite a very long time. Be aware that excerpt is a fancy word for a brief piece taken from a lengthier work. Furthermore, our writers know that buying an argumentative essay is an extremely peculiar practice. Since you can well imagine that such essays aren't written by professionals so they may not be of the quality that you are interested in finding. One of the simplest methods to comprehend how to establish and format this sort of essay is to use an example for a guide. Writing argumentative essays requires a lot of time to finish, especially when you don't have an assigned topic. So when you purchase sample argumentative essays from Ultius, you will have the peace of mind you have earned from a comprehensive writing service. The most frequently encountered paper writing service that the vast majority of our clients require is essay writing. Our consumer writing services are constructed around the idea of providing quality argumentative essays and being the ideal sample writing service on the web. There's a remarkable solution to your issue!

Common English-Language Sentence Patterns and Quiz