Polypharmacy in the Older Adult: Too Much of a Good Thing
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 elderly patients, how to recognize drug related problems, and most importantly how to prevent adverse events.
Causes of Polypharmacy
Polypharmacy among elderly clients occurs for a variety of reasons. There are more drugs now available to treat specific diseases and symptoms than ever before. New discoveries that have lead to new, more effective medications for patients have helped patients in many ways (Bender, 2005). Unfortunately, these discoveries have also fueled inappropriate use of and overuse of medication. Drugs that used to be prescriptions are now readily available over the counter. Also, the use of complementary and alternative herbs is becoming more popular.
Not only does the amount of medication available contribute to polypharmacy, so does the fact that elderly patients are more likely to have multiple health disorders. People over the age of 65 are more likely to have several chronic conditions that require one or more medications to manage (Conry, 2005). When elderly patients ...
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...N., & Urban, C. Q. (2011). Pharmacology for nurses: a pathophysiologic approach. In . Upper Saddle River, NJ: Pearson.
Bender, K. J. (2005). Medication developments for diseases of the elderly. Geriatric Times, 1(1). Retrieved from http://www.cmellc.com/geriatrictimes/g000637.html
Caskie, G. I., & Willis, S. L. (2004). Congruence of self-reported medications with pharmacy prescription records in low-income older adults. Gerontologist, 44(2). Retrieved from
Conry, M. (2005). Polypharmacy: pandora’s medicine chest []. Geriatric Times, 1(3). Retrieved from http://www.cmellc.com/geriatrictimes/g001028.html
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., MacLean, J. R., & Beers, M. H. (2004). Updating the beers criteria for potentially inappropriate medication use in older adults: results of a us consensus panel of experts. Archives of Internal Medicine, 163.
Polypharmacy is the “concurrent use of several differ drugs and becomes an issue in older adults when the high number of drugs in a medication regimen includes overlapping drugs for the same therapeutic effect”(Woo & Wynne, 2011, p. 1426). The patient is currently taking several medications that can potential interact with each other, perform the same therapeutic effect, and creating side effects. The following is a list of her medications and their indications:
...teract. Many of the medications are very powerful in and of themselves. This article also presents additional approaches to medicating the elderly, including focus on reduction of number of medications prescribed. Both articles present the importance of considering the normal physiological changes within geriatric patients.
Omnicare has a direct impact on the health of senior citizens. They should also continue in this area. They can leverage their pharmaceutical expertise to create unique databases and proprietary clinical information services, all focused on providing the safest, most appropriate, most cost-effective drug therapies for the elderly. Their programs and services encourage early diagnosis and treatment, since this usually provides the best quality of life at a lower cost.
(II) The enacting of Medicare Part D in 2006 only helped to fuel America’s hunger for prescription medication. In 2003, President George W. Bush announced and signed the Medicare Prescription Drug, Improvement, and Modernization Act (also known as the Medicare Modernization Act, or MMA) on December 8th. The roughly $400 billion dollar measure was marketed to the American public as something that will provide care for the millions of senior citizens who, at the time, were struggling to afford prescription medication. This was the largest development of Medicare since 1965, which is when the program was initially created, and gave hope to those wishing for positive medical reform. According to title XI of the “Medicare Prescription Drug, Improvement, and Modernization Act of 2003”, the most significant change will be the affordability of prescription drugs by implementing the importation of drugs from Canada, along with necessary safety measures, in order to lessen the cost (United States Congress, 832). For those who were in retirement homes and lacked a steady income, the affordability of drugs was often a deciding factor in the decision to seek medical attention and the idea that those individuals ceased to live simply because they lacked the funds tugged at the heartstrings of many Americans.
Patients are feel difficulty of medication compliance in long term treatment because patient have to be a regular on their medication. However, old people also require an extra attention on medication compliance because sometime noncompliance create a critical situation for them. Sometime patient takes a few dosage of medication and they stop taking medication as soon as they feel well which create a complication on long run. The implications of non-adherence are evident in the outcomes for many diseases, including HIV, cardiovascular disease, type 2 diabetes and high cholesterol (Scholefield,
The pharmacokinetics of Aceclofenac are not altered in elderly patients, therefore it is not considered necessary to modify the dose or dose frequency.
Polypharmacy among the elderly is a growing concern in U.S. healthcare system. Elderly who have comorbities and take multiple medications are at a higher risk for potential adverse drug reactions. Elderly who take over-the-counter medications, herbs, and supplements without consulting their physician are at risk for adverse reactions associated with polypharmacy. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients who continue to take medications which have been discontinued by the physician. There is a great need for nursing interventions regarding polypharmacy, including medication reviews also known as “brown bag”. As nurses obtain history data and conduct a patient assessment, it is essential to review the patients’ medications and ask open-ended questions regarding all types of medications in which the patient is taking. In addition, the patient assessment is also an opportunity for the nurse to inquire about any adverse reactions the patient may be experiencing resulting from medications. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
Tweddle, F. (2009). Covert medication in older adults who lack decision-making capacity. British Journal of Nursing, 18(15), 936-939. Retrieved from https://login.athena.rrc.mb.ca:2047/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=a9h&AN=43777586&site=ehost-live
Ninety-three percent of older adults visit their primary care provider (PCP) annually, offering a unique opportunity for providers to target this population and encou...
Elderly, 1991. American Journal of Public Health, 84(8), 1265. Retrieved from Academic Search Complete database.
Acquiring a comprehensive understanding of the ailments encountered by the aging population is critical for properly providing the care that they require. Physical ailments, often easier to diagnose and treat are perceived to be the most prevalent hardships for aged people. However, studies show that a significant number of seniors are subject to mental illnesses. Thus, emphasizing the need for the important of mental health within the aging population. Though all mental illnesses have an unfavorable impact on the quality of one’s life, depressive and anxiety disorders tend to the most devastating for an elderly person.
As we age, the use of medication is often increased in an effort to treat illness and disease. In older adults this frequently results in the administration of multiple medications, both appropriately and inappropriately, at the same time. This is known as polypharmacy. While polypharmacy can exist with any age demographic, it is much more prevalent in older adults where the risk of multiple health conditions is greater. It is not uncommon, for example, for a patient to be treated with multiple therapeutic drug combinations in order to manage disease such as diabetes, heart failure and chronic obstructive pulmonary disease (Kaufman, 2011, p. 49). Polypharmacy is associated as a major factor placing older adults at risk for an adverse drug event. As the number of medications increase, the need for monitoring becomes much more crucial. When there is a breakdown in proper monitoring, the older adult is significantly placed at a higher risk for negative health outcomes due to serious side effects, poor adherence, adverse drug reactions and adverse drug interactions.
Prescription drug coverage is an important issue because many rely on the day to day help they receive from prescription drugs. Furthermore, the elderly and disabled populations are particularly reliant on prescription drugs and have some of the least means to purchase them (Huh, Rice & Ettner, 2008). The combination of limited income and high drug costs can cause people such as seniors to take risks with their health by trying to extend their medications or go without them.
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 being consumed. This is also an opportunity for the nurse to question about any adverse reactions the patient may be experiencing resulting from medications. Polypharmacy can result from patients having multiple prescribers and pharmacies, and patients continuing to take medications that have been discontinued by the physician. Nurses are in a unique position to provide early detection and intervention for potentially inappropriate medications and its associated adverse drug reactions.
...Jaecker, P. (2009). Medication use and increased risk of falls in hospitalized elderly patients: A retrospective, case-control study. Drugs & Aging, 26(10), 847-852. doi:10.2165/11317610-000000000-00000