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Seniors and the risk of PolyPharmacy

Reflections:

Senior citizens with polypharmacy – Discuss what makes this population at risk and how the risks can be prevented, citing appropriate sources.

The term polypharmacy describes a patient’s use of multiple medications.  Researchers have designated number five (5) or more as the starting point of polypharmacy.  As defined by Webster’s Dictionary – (copied/pasted for accuracy)the practice of administering many different medicines especially concurrently for the treatment of a single disease also the concurrent use of multiple medications by a patient to treat usually coexisting conditions and which may result in adverse drug interactions.

An age-related physiological change greatly improves the risk of ADEs (Adverse Drug Effects), which accounts for more than 10% of hospital admissions among older adults.  It is believed that many of these admissions are preventable. Because of the pharmacokinetics and pharmacodynamics activity in the body, the following are quite common in seniors.

  • Lower levels of stomach acids

  • Heavier B.M.I.’s (Body Mass Index)

  • Less fluid retention

  • Kidneys and liver receive less blood flow as the body ages

  • Increase/decrease of receptor sensitivities

In addition, it has been found the following stimuli also influence the execution of polypharmacy among seniors:

  • Demographics – Financial capabilities or lack thereof.

  • Comorbidities

  • Inappropriate prescribing – Apprehension to over-ride or adjust another prescription issued by a different Doctor.

  • Fragmented health care system – what tool should be used? The Beer’s Criteria the START/STOPP Tools or the ARMOR protocol?

Beers Criteria. Geriatrician Mark Beers create the Beer’s in 1991 and since it has been accepted as the “golden” standard by the American Geriatrics Society (AGS).

START/STOPP TOOLS, The Screening Tool of Older People’s Prescriptions (STOPP) and the Screening Tool to Alert to Right Treatment (START) were first published in 2008 by Gallagher and colleagues from the Department of Geriatric Medicine at Cork University Hospital in Ireland.

ARMOR Protocol, The Assess, Review, Minimize, Optimize, Reassess (ARMOR) protocol was initially used in a long-term care setting, though its use is encouraged in the outpatient setting as well.  The primary goal of application is to preserve the patient’s functional status and quality of life.

 

Efforts to reduce polypharmacy in seniors has shown when evaluating a patient, providers can use the above mentioned tools to minimize polypharmacy.   However, it does require clinicians to broaden their focus, not only on the number of drugs a patient takes, but also the prescription of potentially inappropriate medications and potential prescribing omissions.

The steps necessary to perform these tools will require that the clinicians scrutinize medication lists during every patient visit and review the dosages.  Analyze for drug–drug interactions, question and follow for adverse drug withdrawals.  And identify potential problems with current medications

 

Credits:

 

American Journal of Nursing – CE: Mitigating the Dangers of Polypharmacy in Community-Dwelling Older Adults

Gabauer, Jaclyn MSN, RN, APN, AGCNS-BC, PCCN

https://journals.lww.com/ajnonline/Fulltext/2020/02000/CE__Mitigating_the_Dangers_of_Polypharmacy_in.25.aspx

 

Dangers of Polypharmacy – an open access peer-reviewed chapter. https://www.intechopen.com/chapters/55307

By Pamela L. Valenza, Thomas C. McGinley, James Feldman, Pritiben Patel, Kristine Cornejo, Najmus Liang, Roopa Anmolsingh and Noble McNaughton

Submitted: October 11th 2016Reviewed: April 12th 2017Published: September 13th 2017

DOI: 10.5772/intechopen.69169

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