Geriatric polypharmacy Polypharmacy refers to the use of four or more medications by a patient who is generally over the age of sixty-five also known as the geriatric population. While other populations are at risk, elderly patients have a higher rates of chronic illness which leads to taking several different medications. They are more likely to have numerous doctors causing poor communication between the groups of providers. This leads to different medications getting prescribed that can cause adverse reactions, overdoses and death. Adverse drug events occur in fifteen percent or more of the geriatric population that come to offices, hospitals, and long term care facilities. Nearly fifty percent of older adults take one or more …show more content…
If the elderly patient is taking five or more medications there is a thirty percent increase in medical costs (Kojima, Akishita, Nakaumura, Nomura, Ogwawa, Iijima, Ouchi, 2011). The patient’s functional status has been known to decline in these circumstances such as a decline in th3e ability to complete activities of daily living. Cognitive impairment, including both delirium and dementia, have been associated with polypharmacy along with falls, urinary incontinence and possible malnourishment. This research paper will include a summary of the patient population, a proposed solution including goals, barriers, benefits, and timeline of major steps to be taken for implementation of the proposed solution, the parties that will be involved and lastly, implemented solutions. Patient Population In general, older people are living longer than ever before. They are healthier and more diverse than in past generations. However, with increasing age comes disability and illness. Many elderly adults are disabled in one or more way and will most likely turn to health care to treat them. As the elderly population increases and the longer they live, they will require more help with activities of daily living and chronic disease management including medications (Kojima, Akishita, Nakamura, Nomura, Ogwaw, Iijima). Non-adherence can occur in all elderly and occurs more when the patient is prescribed multiple
The first step in Lester Browns “Plan B” strategy is that humans have to reduce the amount of CO2 emissions by eighty percent by the year 2020. Second, is stabilizing the human population by not allowing the total number to exceed eight billion. Third, he believes that we need to eradicate poverty on a global scale. The last step in this plan is to restore the earth’s natural systems including aquifers, forests, grasslands, fisheries, etc. Research has shown that investing in the education of women have an important impact on population. It has been shown that if women are educated they marry later and have fewer children. These fewer children are also likely to repeat the cycle of their mother and continue have a reduction in the population.
Polypharmacy, described as an individual taking more than four medications, can be concerning with the aging population. Polypharmacy concerns include adverse drug reactions, drug interactions, higher cost, decreased mobility, decreased quality of life and cognition impairment. Those at greater risk of negative polypharmacy consequences include elderly, psychiatric patients, recently hospitalized, individuals with multiple doctors or pharmacies and people with impaired vision or dexterity. There are times that polypharmacy is at times needed to help a person with their diagnosis, an example of this is using multiple medications to treat congestive heart failure which can include digoxin, diuretics, and angiotensin-converting enzyme inhibitors
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.
Inappropriate prescribing commonly occurs in adults aged 65 or older, who have a higher prevalence of chronic disease, disability, and dependency (Page II, Linnebur, Bryant, & Ruscin, 2010). Exposure to inappropriate medications is associated with increased morbidity, mortality, and health care utilization (Page II, Linnebur, Bryant, & Ruscin, 2010). Below is a list of measures that concentrate on the prescribing of correct medications in the hospital
The concepts of chivalry and courtly love were deeply embedded into medieval English culture. A strict code of conduct existed that dictated how honorable men acted. This code required that men use their strength to protect and defend the weak, never to take advantage of them. The principles of chivalry were very godly, but the author of Sir Gawain and the Green Knight saw some flaws in them. The author felt that despite the importance of chivalry, society required men to behave in foolish ways in the name of chivalry. In this story, the author honors chivalry in general but ridicules foolish traditions practiced in the name of the concept.
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
However, they also increase overall mortality and increase their cognitive impairment. It was seen that those on the medications were more prone to falls, leading to hip fractures. Withdrawal from the medication actually reduced the residents fall risk as well as increased their verbal fluency (Jordan, 2014). So despite all of these warnings and known risks doctors are still determining that the pros outweigh the cons and are prescribing these drugs to dementia patients. It would appear that pharmaceutical companies play are huge role in contributing to this problem. These companies are improperly promoting their drugs to be used for these groups of people (Levinson, 2011). Elderly are already a vulnerable population and these pharmaceutical companies are preying on them simply for financial
Elderly patients that take several medications compound the risk of developing an adverse drug reaction. Not only does the aging process have an effect on how elderly bodies process medication, but elderly people take more medications than their younger counterparts. According to Conry (2005), the elderly patient takes an average of 5 prescription medications and two non-prescription medications (Conry, 2005). While medications are frequently necessary to enhance the quality of life of the elderly, non-pharmacologic methods should be used whenever possible. Healthcare providers need to understand how aging impacts the body’s response to medications, which drugs pose more risk to
Working directly in patients homes we have access to their medication cabinets, doctor orders, and medication sheets. Thorough review of their medications is the first step to identify polypharmacy. Lui, (2014) discusses the approach of deprescrbing unnecessary medications. Stopping unnecessary or harmful medication is an often overlooked yet important component of geriatric practice. This process may be time-consuming, as there are many factors to consider when deprescribing medications in elderly patients.
Providers should ensure that patients are receiving therapeutic benefits from their medications and inquire about any new or unusual symptoms during follow up visits (Lewis, 2017). As the body ages, body fat and water composition are altered which can impact therapeutic drug levels or drug elimination (American Nurse Today, 2017). Ways nurses can improve polypharmacy is to teach patients “each medication, including its name, appearance, purpose and effects” (American Nurse Today, 2017). Nurses and providers must provide good communication when educating patients on instructions (American Nurse Today, 2017). Another solution for polypharmacy is to “keep it simple” and when possible, limit the number of medication changes (American Nurse Today, 2017).
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.
As a result, an increasing number of seniors (who may already be suffering from physical and mental health problems and who may be on a fixed budget) are becoming addicted to the medicines that were supposed to help them. Addiction to prescription medication is an often poorly understood problem and one that can quickly tear a person 's life and health to shreds.
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
It can be determined that the elderly seldom get drugs illicitly. As stated earlier, they usually get drugs by seeing multiple doctors. In addition to this, they stockpile prescribed medications over time, or getting medications from family members. This only contributes to the problems of the elderly. Often times, family members are reluctant to address the issues their elderly family member face.
The selection criteria were based on sticking to the key PICO words. Studies that involved both kids and adults were avoided, as the population being studied was strictly adults. Of the final 11 articles in PubMed, three RCT’s, and one SR/MA were selected. Two of those eleven were studying babies/children in conjunction with adults, so they were excluded. One study focused only on the prevention of CDI, and there was no mention of AAD, so that was eliminated in order to stick to the dependent variable of AAD. Three of the eleven were solely studying geriatric patients, and the population is adults (19+). One of the eleven studies only focused on spinal cord injury patients, and that did not correlate with the population of adults.