When we hear the word polypharmacy, we think about the number of medications taken on a daily basis. Reading through researched journals, there is really “no consensus regarding the number of medications as to how polypharmacy begins” (Fried et al., 2014, p. 2261). According to Maher, Hanlon, and Hajjar (2014) reported, “polypharmacy is the use of more medications than are medically necessary” and “ medications that are not indicated, not effective, or constitute a therapeutic duplication would be considered polypharmacy” (p. 1-2). With this in mind, most of our patients who are elderly or even younger adults have more than one existing chronic condition and interlinked with several other co-morbidities requiring them numerous medications to treat each conditions. Unfortunately, polypharmacy creates unfavorable consequences to those taking more than one prescription drug especially individuals who are elderly as the prevalence increases with age. Those that have been prescribed with greater than one pill typically experienced adverse drug reactions [ADR] and drug-to-drug interactions. Accordingly, it was noted the repercussion of taking countless drug medications could result to multiple outpatient/ urgent care visits or hospitalization. A systematic review by Hamid, Ghaleb, Aljadhey, and Aslanpour (2013) identified “old age and polypharmacy” as risk factors to hospital admission caused by ADR’s and /or adverse drug events. It was attributed to people who are elderly and
In today's society people are quick to find easy and fast ways to make them feel better or reduce stress leading to long term health problems. Medication is designed to ease someone or somethings pain, but overusing a drug can result in side effects that can force someone to need more drugs to get better. Siri Carpenter believes that the use of multiple and unnecessary medication is escalating and frightening. “The use of multiple, often unnecessary medications — especially among older people — is an entrenched, escalating, frightening, and mostly unexamined problem in modern healthcare care,” (Carpenter 1). People find it easy to take
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
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
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-
The Mayo Clinic, a world-renowned education, research, and health facility estimates that over 70% of American rely on at least one prescription drug to treat some form of medical condition. In reality, many of these people rely on multiple prescription drugs to sustain their lives, like drugs to reduce their high blood pressure.
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
According to an article written by Anna Gorman of Health Leaders Media, the use of prescription drugs is a growing concern. The article mentions Lola Cal, a patient in a geriatric unit in Santa Monica, California whose medical records show that she is on 36 different medications. Although people born from 1946 to 1964, known as the baby boomer generation, only make up 16% of the U. S. population, this generation accounts for one-third of prescription drug use. Many elderly patients take several medications to treat chronic illnesses and raise their chances for serious side effects and dangerous drug interactions. Dr. Maristela Garcia, director of the inpatient geriatric unit at UCLA Medical Center in Santa Monica states that polypharmacy is “America’s other drug problem.
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
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Patients who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. There is a great need for nursing interventions in conducting a patient medication review also known as “brown bag”. As nurses obtain history data from patients at a provider visit, the nurse should ask “what medications are you taking?” and the answer needs to include over-the-counter medications as well. If the response does not include any medications other than prescribed meds, it is incumbent upon the nursing professionals to question the patient further to ensure that no over-the-counter medications or supplements are
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).
Tissot E, Cornette C, Limat S, et al. Observational study of potential risk factors of medication
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.
Pharmacist say they've had older people taking 3-5 prescriptions, that are confusing them because some are nullifying each other. Meanwhile doctors are over prescribing medications and patients are becoming junkies. Most people taking that many prescriptions hardly even know what drug it is.