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.
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...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.
(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.
Today?s healthcare environment calls for continued cost containment while providing better, quality care. As a result of the advances of healthcare, life expectancies have increased resulting in a growing, aged population with more chronic conditions. Treatment options, outside the hospital, are the norm for most routine management of patient care, but when someone gets sick, and requires hospitalization, the combination of their age, chronicity of illness and increased comorbidity
Hochadel, M. (2014). Mosby's Drug Reference for Health Care Professionals (fourth edition ed.). : Elsevier.
The nursing profession is guided by the principal of nonmaleficence, or “Do no harm”. Nurses are responsible for maintaining and optimizing a patient’s quality of life. When nurses fail to care for themselves, they also put their patients at risk. The patient has a reasonable expectation to receive safe and competent care. The influence of drugs and alcohol greatly deteriorate the judgment and skills of any good nurse. Increased patient workload, long hours, personal stress, and sleep deprivation put many nurses in a position to self-medicate. It is my position that high-risk specialty employees undergo drug testing in order to be held accountable and help keep their patients and themselves safe from harm.
The U.S. Department of Health and Human Services (2013) Report revealed that the World Health Organization describes the inequities and disparities within a community as social determinants. These social determinants include age, sex, birth place, where one lives, works, plays, race, ethnicity, sexual orientation, disability, and has a healthcare system. McKibbin and Deacon (2011) revealed it is estimated that 20% of older adults suffer from a mental health disorder. Patients with a chronic illness such as coronary artery disease, congestive heart failure, hypertension, geriatric depression, chronic pain issues, cancer, and diabetes account for trillions of dollars spent on medical care in the United States. As the population ages the costs will expand, the shortage of physicians and nurses will continue to decrease and the scope of this problem will increase thus the need for new innovative ideas and plans to care for the geriatric population including those in the rural regions. One potential solution for geriatric depression ...
The American Nurses Association (2008) has defined the FNP, under the broader title of Advanced Practice Registered Nurse (APRN), as one “who is educationally prepared to assume responsibility and accountability for health promotion and/or maintenance as well as the assessment, diagnosis, and management of patient problems, which includes the use and prescription of pharmacologic and non-pharmacologic i...
There are profound effects of ageism that can be harmful to a patient’s overall health. Ageism can cause physicians to consistently treat older patients unequally compared to younger adults. Unequal treatment can be divided into the under-treatment of symptoms and the over-treatment of symptoms. The imbalance in how a physician would treat a geriatric patient is ageist because the older adult is not getting fair treatment in every case. Under-treatment and over-treatment are different; however, they are both equally as harmful to a patients health.
The expected hierarchy among health care providers is led by physicians. The doctor has long been the “expert” on anything to do with the human body, whether it is disease or injury. The evolution of technology brought the World Wide Web readily to every consumer’s doorstep resulting in a slight shift of this everlasting faith. Older adults continue to retain some of this confidence in their physicians due to their tendency not to use the internet and search for their own ...
Drug use appears to negatively affect the health of the elderly at a higher rate than other populations (Benshoff & Koch, 2003). This may be a result of old age. So, it can be understood there is a biological effect of substance abuse among the elderly. The elderly are more susceptible to being admitted into the hospital for adverse effects of substances, while other populations of society are not. Benshoff and Koch asserts, “Intentional abuse of prescription medications to get high is thought to be rare, but over-use does occur among this population. Often this over...
If the older patient’s complaints during a routine office visit are being ignored because of their chronological age, successful aging and quality of life will certainly be impacted by lack the of treatment for potential mental conditions. The fact that this ignorance can directly lead to suicide among this particular cohort more than any other group is frightening. Considering that social isolation is a primary reason for the onset of depression among older adults, the importance of physician and other health care provider identification of depression through screening and preventive measures are imperative. According to Blakemore (2009), 40 percent of older people who visit their general physician, half of older adult inpatients in general hospitals and 60 percent of long-term care residents have mental health problems and are often denied access to the same mental health services as younger adults including psychological therapist and drug interventions (p. 6). These numbers are astounding among a group of individuals whose physical health could be directly impacted by improved mental health care. Again, the ageism that influences screening and prevention among older adults is directly impacting the quality of life and chance at active aging among the older population.
Although there is evidence from many studies that disability rate is declining in the U.S.2, the rapid expansion of the oldest-old age group will continue to pose health care challenges for future generations. Disability prevalence rates are very high in the oldest-old3 and even reached 97% in centenarians4. These high rates of disability will have a tremendous financial impact in the future as people living with disability have much higher health care expenditures5.
Drug administration forms a major part of the clinical nurse’s role. Medicines are prescribed by the doctor and dispensed by the pharmacist but responsibility for correct administration rests with the registered nurse (O'Shea 1999). So as a student nurse this has become my duty and something that I need to practice and become competent in carrying it out. Each registered nurse is accountable for his/her practice. This practice includes preparing, checking and administering medications, updating knowledge of medications, monitoring the effectiveness of treatment, reporting adverse drug reactions and teaching patients about the drugs that they receive (NMC 2008). Accountability also goes for students, if at any point I felt I was not competent enough to dispensing a certain drug it would be my responsibility in speaking up and let the registered nurses know, so that I could shadow them and have the opportunity to learn help me in future practice and administration.
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
Firstly, nurses are expected to practice evidence-based health care hence a mastery of information about the essential and safe dose of drugs for a patient is very important for a nurse. Consequently, it could be the determinant between the life and the death of the patient. Pharmacology is a discipline which is mandatory for the nurse to excel in to be efficient in discharging his/her duties. Understanding which drug to use, the right dosage, the expected side effects which may occur and the contra-indications of the various drugs are key in the preservation of