Polypharmacy in the Older Adult
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Improvement in the quality of healthcare has led to a significant increase in the life expectancy of individuals. The aging population puts significant strain on the healthcare systems. This is due to the various ailments that are associated with old age. Aged populations need constant care. Various ailments necessitate the older adults to take various drugs. However, as the number of drugs increases the risk of polypharmacy increases. Polypharmacy may lead to several complications on the older adults. Polypharmacy may lead to adverse drug reactions, drug-drug interactions, or non-adherence of patients to the prescriptions. This necessitates medical practitioners, particularly nurses to come up with strategies to help in reducing polypharmacy. Some of the strategies include medical reviews, simplifying the medical regiment, requesting the older adult to obtain medication from one pharmacist and regular evaluation of the medical cabinets of the older adults. Polypharmacy is just one of the problems healthcare providers face due to the aging population. The problems are bound to increase as the life expectancy continues to rise.
Polyphamarcy means taking many drugs. It refers to problems that may occur because of a patient taking more drugs than are necessary. This problem is common mainly in adults. Despite constituting only 12.7% of the US population, older adults consume 34% of all prescription drugs. Moreover, older adults consume 40% of all nonprescription drugs. People aged between 65 to 69 take about 14 prescriptions annually, whereas people aged between 80 and 84 take an average of 18 prescriptions annually (Mauk, 2010). The statistics clearly show why older adults are more prone to polypharmacy.
Problems Associated With Polypharmacy
Polypharmarcy in older adults leads to several consequences. The consequences range from slightly annoying to life threatening. Prescription of multiple drugs by medical practitioners leads to non-adherence of the prescription. This is mainly because it is perceived as expensive and complicated. Non-adherence is the degree in which patients are unwilling to adhere to the instructions of prescribed medication (Mauk, 2010). Non-adherence may to the worsening of the ailments that the older adults are suffering.
Polypharmarcy may also lead to occasional occurrences of adverse drug reactions (ADRs). ADR is the harmful reaction to a drug that is “undesired, unintended, or unexpected in recommended doses” (Mauk, 2010, p. 456). More than 30% of ADRs comprise of older adults with about 95% of the cases being predictable and preventable. Upon the occurrence of ADR in an older adult, it becomes necessary for medical practitioners to provide an advanced level of care to treat the reactions completely (Mauk, 2010). This leads to an increase in the mortality of the older adults.
Polypharmarcy also leads to an increase in the drug-drug interactions. Drug-drug interactions refer to interactions that may occur when an individual consumes two or more drugs simultaneously. The risk of drug-drug interaction increases as the medication of the individual increases. Treatment of complications due to drug-drug interactions also requires advanced care (Mauk, 2010).
Several measures can lead to the control of polypharmacy in the older adult. Older adults aged 75 years and above should attend medical reviews every six months, if they are taking more than four prescription drugs. Patients who take fewer than four medications should go for medical reviews annually. Medical reviews help in evaluating the effectiveness of drugs and determine healthcare needs of the older adult. The reviews should comprise of face-to-face contact between the medical practitioner and the older adult. During the review, the patient should review all drugs that they are taking with the medical practitioner. In addition, the clinician should ensure that the older adults bring the actual bottle of every drug that they take (Stuart-Hamilton, 2011). Medication reconciliation for both inpatients and outpatients significantly helps in reducing polypharmacy.
Nurses can also help in reducing polypharmacy by simplifying and streamlining the medication regimen of the patient. This would help in improving the adherence of patients to the medication. The nurse may use doses that have once daily or twice daily dosing to reduce the frequency of the dosing (Mauk, 2010). In addition, nurses should consider non-pharmacological methods of treating various medical problems that the older adult faces. For example, instead of prescribing laxatives and stool softeners for constipation, the nurse may request the older adult to take more fluids and manage his diet (Bernstein & Luggen, 2009).
The nurse should instruct the older adult to obtain all medications (whether they are prescription or nonprescription drugs) from one pharmacy. This would ensure that pharmacists check the drugs for interactions that may be dangerous. The pharmacist can help in maintaining a list of the prescription drugs that the older adult is taking and screening for any potential drug-drug interactions. For this to be efficient, the nurse should encourage the patient to know the patient personally (Mauk, 2010). The pharmacist would significantly help in reducing the supervision that the nurse should have on the older adult.
The nurse may provide the older adult with containers that are easy to open, if the older adult does not live with children. The nurse should encourage the patient to request for labels that are easily readable or read the labels with a magnifying glass. The nurse should ensure that the older adult does not share drugs with other people. In addition, the nurse should check the medication cabinets of the older adults to ensure that there are no medications that the older adult no longer requires. The nurse should inspect the medical cabinets at least once annually (Mauk, 2010).
Polypharmacy is one of the major problems facing older adults. It leads to the development of several health problems, some of which may be life threatening. Use of efficient strategies may lead to a significant reduction in polypharmacy. The nurse plays a crucial role in the formulation and implementation of the strategies. Medical reviews, simplifying the medical regiment, requesting the older adult to obtain medication from one pharmacist and regular evaluation of the medical cabinets of the older adults would greatly help in reducing polypharmacy.
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