Polypharmacy in elderly patients: causes, consequences, and reduction strategies

Organizational Leadership Strategies

Falls in the elderly due to polypharmacy and possible approaches

Polypharmacy refers to the use of multiple medicines by the elderly especially those above sixty years. Most times, it involves the use of more than five regular drugs. Alternatively, it is sometimes referred to as unnecessary prescriptions or purportedly excessive medication. Polypharmacy has not yet achieved a universal definition. This problem has been persistent across forty percent of the elderly population that reside in their own homes (Menaker, 2010).

Polypharmacy might be appropriate: most times, it tends to be inappropriate. Polypharmacy is associated disadvantages such as an increase in adverse reaction towards drug intake, prescribing cascade, higher costs and drug vs. drug interaction. Polypharmacy leads to a decrease in life quality, cognition and mobility. The use of multiple medications is common even in fair illness and does not indicate poor treatment. Studies have repeatedly shown that an inhibitor, aspirin, antidepressant, and paracetamol are mostly used at once (Miller, 2005).

Various researchers have proposed possible approaches to reduce Polypharmacy in elderly patients. Medical providers caring for the elderly use a medical grid to monitor the patients who are ready to be discharged. This comprises of a list of all drugs and the administration time over the previous month. This approach tends to reduce the number of drugs in a group of patients against the increase of medication. It also reduces the number of dosage taken each day by elderly patients. A research study by a New York Medicare group on primary care physicians found that patients are required to bring along their medications for regular reviews. This survey also found it effective for primary care providers to receive guidelines on Polypharmacy. During a medication review, some physicians tend to give patients a drug discontinue or change the medication change (Drenckpohl, Bowers & Cooper, 2007).

A number of researchers found out that primary care providers mail physicians a list of clients who are on potentially inappropriate medication. This results in medical discontinuation. Clinical pharmacists are being used to aid and educate physicians on how they can reduce Polypharmacy among elderly patients receiving outpatient care. This approach has been effective because it has reduced the rate of elderly patients receiving more than five medications. Surveys have also described the overall rate of Polypharmacy cases as the intake of three oral anti-diabetic medications, two benzodiazepines, and two narcotics: these add up to five medications. Such mailings to physicians have reduced the number of patient medication (Varkey, Sathananthan, Scheifer, Bhagra, Fujiyoshi, Tom & Murad, 2009).

Clinical approaches to Polypharmacy

Before a caregiver prescribes a new medication, it is crucial to obtain a thorough history of patient medication. Both non-prescription and prescription medications must be considered: the patient must carry it to the healthcare provider. After assessing the patient's medical history, then the care provider can proceed and decide whether it is necessary to add more medication and if the benefits would outweigh the risks. In some cases, Nonpharmacologic therapy like exercise or diet modification might be appropriate instead of additional medication. Proper dosing must take into account patient's hepatic and renal function along with the drug's adverse event profile, pharmacodynamics, and pharmacokinetic (Varkey, Sathananthan, Scheifer, Bhagra, Fujiyoshi, Tom & Murad, 2009).

For the elderly, doses must be at a lower rate administered differently than in young patients. This helps in preventing toxicity from occurring. Care providers must evaluate the state of all concomitant diseases and drug-drug reactions to improve patient adherence. Patient adherence can be enhanced through educating both patients and their family members about their medications. Limiting drug prescription, considering generic options, simplifying drug regimens to simple medications and making use of compliance aids are some of the tactics that may help motivate families enhance adherence. Assessing medication regimes and setting reasonable therapeutic goals are very vital in ensuring that polypharmacy does result in unnecessary medical risks (Hines & Yu, 2009).

Conclusion

Polypharmacy has become common across the elderly generation. An array of studies proves that assortments of medications are linked to adverse health outcomes. However, more studies have found that there is an urging need to delineate the impacts linked to unnecessary intake of drugs. Healthcare practitioners ought to be aware of the associated threats and evaluate all medications at every single patient visit. This would help curb the recurrence of Polypharmacy (Drenckpohl, Bowers & Cooper, 2007).