Managing Multiple Morbidities On Older People

Fulton, M. M. & Allen, E. R. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 2005, 17: 123-32. Received from PubMed database (15819637).

Although people are living longer nowadays, older age is often accompanied with chronic illness and disabilities. According to a geriatric study done by Nursing Outlook, about 80% of people age 65 and older have at least 1 chronic illness such as heart disease, diabetes, or arthritis. Having to deal with hypertension, osteoporosis, and heart disease all at the same time is unimaginably difficult. These conditions affect their quality of life and also increase the need for their long-term care. Hospitals are going to find that a

Senior citizens are the people who are most likely to take multiple medications due to the occurring chronic conditions as the aging process continues. Given the several medicines they take, they are ironically the age group that is very much sensitive to medication side effects, both therapeutic and negative.

Nearly half of seniors do not take their medications when or how they were prescribed. There are mistakes on dosages, methods of delivery, time of delivery, what they should be taken with, and even if they should still be taken. Compounding the issue, most seniors over the age of 65 are taking between 8 and 13 different medications. Put these numbers together and it is no wonder that problems with medication management are one of the leading reasons seniors end up in the emergency room, and is the number one reason seniors end up back in the hospital after being recently discharged. According to a study published in "Pharmacotherapy", nearly 70 percent of hospitalized seniors suffered from at least one

As the elderly population increases so will the occurrences of ADEs. For this reason, it is important to protect the elderly patient from these negative consequences of polypharmacy. This is accomplished by understanding how the aging body reacts to medications, understanding which drugs are the most problematic for the elderly patient, and how to spot a drug-related problem and

Drug therapy always carries risks, but in older populations, that risk is at times amplified due to normal physiological variations. When considering drug therapy for an older

As the population continues to live longer the older adult has had an increase in chronic conditions develop, resulting in an increase in multimorbidity. This causes the older adult to be more vulnerable to disability, poor quality of life, risk of death and adverse drug reactions (Salive, 2013). In general, the older adult is vulnerable to having an adverse reaction to medications. The older adult not only has a higher risk of an adverse reaction to any particular medication given, there is an increase in risk of reactions associated with the multiple medications older adults are frequently prescribed due to multi-chronic conditions (Hubbard, O’Mahony, & Woodhouse, 2013). Adverse drug reaction and multimorbidity can benefit from additional research to better understand the older adult reaction to medications and dosages, as well as management of multimorbidity. Until then physicians, nurses, the older adult, and the family need to collaborate to find the treatment plan that works best with the least amount of side effects from medications. Often times starting low with medication dosing and increasing to the dose to achieve therapeutic levels is done with the older adult to help decrease an adverse reaction to medication. Management of multimorbid conditions in which maximizing the quality of life the older adult has is the goal. This can be done by frequent assessment of the treatment plan and making

For older adults, nurses should recognize that dosage of these drugs may need to be decrease due to their toxic effects. Baseline renal and liver function tests should be done

In elderly people, polypharmacy is known to be associated with adverse drug events otherwise defined as “presence of untoward and unintended symptoms, signs or abnormal laboratory values arising from the appropriate or inappropriate use of prescription or over-the counter medications” (13).

The main concern about having the elderly on so many medications at once is the chance of adverse drug reactions from potential drug interactions. They can be on both prescribed medications and over the counter medications, vitamins, or supplements. The most common over the counter medications that often lead to serious adverse drug reactions include acetaminophen, ibuprofen, and aspirin (Woodruff, 2010). Another reason that the elderly are more susceptible to adverse drug reactions is the fat and water composition changes, they have increased fat storage and decreased total body water, this allows for higher concentration of water soluble drugs and longer half-lives of fat soluble drugs (Woodruff, 2010). Changes in the liver and

Optimizing drug therapy is an essential part of caring for an older person. The process of prescribing a medication is complex and includes: deciding that a drug is indicated, choosing the best drug, determining a dose and schedule appropriate for the patient's physiologic status, monitoring for effectiveness and toxicity, educating the patient about expected side effects, and indications for seeking consultation. Multiple factors contribute to the appropriateness and overall quality of drug prescribing. These include avoidance of inappropriate medications, appropriate use of indicated medications, monitoring for side effects and drug levels, avoidance of drug-drug interactions, and involvement of the patient and integration of patient values.

The geriatric population is a very vulnerable population, which needs great care. The main concerns are attributed to the age, educational background, medication experiences, living conditions and diet. All these contribute to factors which make it difficult to be adherent to their goals, which have been developed to improve their health.

“polypharmacy as the use of five or more prescription medications—is common among seniors and can lead to reduced compliance with medication regimens and problems with drug–drug interactions” (2012, p.428). Elderly patients are mostly at risk to polypharmacy issues due to aging effects on how the body tolerates medications, and also, as a result of taking more medications than younger patients. Reason et al., continues to demonstrate that the use of prescription increase with age and in association with multiple morbidities in the elderly patients. Medications such as over the counter drugs, herbal preps, and home remedies are widely used by older adults. These medications have a higher risk of causing adverse drug reaction especially with

To ensure the best health care provided to older adults, nurses need to apply the nursing process to all their patients to reduce their hospitalization and help them live better lives. This also provides the health care provider all the information needed to plan their care. L. Lilley, S. Collins, and J. Snyder (2013) explain the importance of lifespan considerations with elderly patients, “More than 80% of patients taking eight or more drugs have one or more chronic illnesses. More complicated medication regimes predispose elderly patients to self-medication errors, especially those with reduced visual acuity and manual dexterity.” (p. 43) Considering our patients age of being over 65, special considerations are needed

The pharmacokinetics and pharmacodynamics of many commonly used drugs vary significantly across all age groups. Adverse Drug Reactions are one of the major concerns in the elderly. Adverse drug reactions, especially those that may be preventable, are among the most serious concerns about medication use in elderly in clinical setting. The incidence of adverse drug reactions in patients more than 60 years old compared with younger patients (age less than 30 years) increased by two or threefold. The ageing process is associated with physiological and pathological changes. It then makes individuals at a higher risk of multiple morbidity and treatment-related complications. Predisposing factors to adverse drug reactions which have been noted including