Polypharmacy Among Elderly

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

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).

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

Older adults commonly take NSAIDS chronically. There are a lot of adverse effects associated with chronic NSAID use including the risk of peptic ulcer disease, acute renal failure, and stroke/myocardial infarction, as well as exacerbate a number of chronic diseases including heart failure and hypertension, and can interact with a number of drugs (eg, warfarin, corticosteroids) ultimately increasing hospitalizations in the elderly population.

The US is an aging society like many societies around the world and as a result, there is an increase in the number of patients admitted to nursing homes. The elderly population is a fragile population that undergoes mental and physical decline in health. This increases the number of medications used, which increase the risk of adverse drug reactions due to drug-drug and drug-disease interactions. Pharmacists have become increasingly active in nursing homes by providing medication therapy management services, but the benefit in reducing prevalence of these adverse drug reactions is not fully understood. Medication therapy management is a growing field that has been incorporated by pharmacists in different states to optimize therapeutic outcomes in individual patients. Understanding the relationship between medication management and drug- drug

Perhaps the most challenging aspect of older adult pharmacology is the concomitant use of multiple medications. Among community-

In the United States today, the elderly make up approximately 13% of the population but use 30% of all prescriptions written. This article focuses on the importance of understanding patients’ prescriptions and their adverse drug events (ADE), as well as the best ways to care for patients with many prescriptions. The article also discusses the best ways to avoid ADEs.

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).

Dosing. Physiologic changes in the elderly make medication dosing tricky. Adjustments have to be made owing to age-related reduction in liver and kidney functions, as well as the presence of coexisting comorbidities and use of other medications for these pre-existing conditions. The BEERS list, a compilation of potentially harmful medications to the elderly, was drafted in an attempt to curb the rising incidence of avoidable adverse medication effects in this population.

De-prescribing is, therefore, a complex process that is required for the safe and effective cessation of inappropriate medications to improve the quality of life (Hasler, Senn, Rosemann, & Neuner-Jehle, 2015). Page et al. (2016) suggested a five-step approach for safe and successful de-prescribing: (1) consider all medications currently taken and the indication for each medication, (2) evaluate the overall risk of medication-induced harm in an individual, (3) assess each medication for its potential to be de-prescribed, (4) sort medications by the order of priority to de-prescribe, (5) implement and monitor de-prescribing regimen. While de-prescribing appears feasible and relatively safe to reduce the impact of polypharmacy in older adults,

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.

During a interview with County Pharmacists Associations newly elected president, Lillian Shisehaunt, pharmacist, said there were a few concerns that needed to be made aware of. She began to speak the concerns about how older people are taking way too many medications at the same time. In this meeting, other pharmacist agreed to the statement stated as well.

According to the Health Care Finance Administration (HCFA), on July 1, 1999, established a quality indicator that residents taking nine or more medications will be used to identify long-term facilities where medications potentially are overused and residents may be at increased risk for adverse drug reactions (ADR). However, this approach can be controversial because the medication is essential for older people health safety. There are many factors on the overuse of medication which can include age, health and the number health care visits. Especially on home care and long-term facilities, most of the elderly in this facilities are forced to take these medications due to facility policies (Hanlon, 2001). Another

The concept of “deprescribing medications” as mentioned in your paper is an interesting topic. This is a relativity new concept that the use of multiple medications that can increase the risk of adverse drug reactions to the patient. When polypharmacy is apparent, the risk of drug interaction falls hospitalization and death can occur. The APN has a role in the medical profession to start a trend of watching over and deprescribe medication for the polypharmacy patients. While compiling the prescribed medication and the medication the patient consumes the chance that they can overlap each other and cause harm is increased. With the elderly population deprescribing by tapering, stopping, and or discontinuing medication