How many people do you know who routinely take more than one medication? More than two? Now, look in your own medicine cabinet and read the labels. How many medications do you have that each contains acetaminophen or ibuprofen? Taking multiple medications and multiple medications containing the same ingredients are two examples of polypharmacy.
Polypharmacy literally means “many medications,” and although it may mean the deliberate use of multiple medications to treat multiple conditions, it may also represent the unnecessary prescribing and use of more medications than are clinically indicated, the simultaneous use of the same medication in multiple forms, or any unnecessary medication in a prescribed regimen (Rounds et al., 2013). Polypharmacy can result in falls, changes in cognition and a variety of adverse events in older adults.
In older adults, the use of medications – even those that are indicated – is a balancing act. A change in the aging body’s physiology and how the body uses, distributes, and excretes drugs means that the older adult is at greater risk for unanticipated and often preventable side effects. In addition to changes in physiology, several other things increase the risk for polypharmacy including: 1) multiple co-morbid conditions, 2) poor adherence to medication regimens, 3) multiple prescribers, 4) prescribers with inadequate knowledge of geriatrics, and 5) self-medication or sharing of medications (Rounds et al. 2013).
Several strategies can be used to reduce polypharmacy and the associated risks of inappropriate medication use in older adults. For health professionals, careful assessment of medications is the first step. Ask patients to bring all of their medications with them when they have clinic visits. Some call this the “paper bag” test – put all the medicines in a bag and bring them along. Also, be suspicious of changes in behavior or function in an older adult. Medications should be near the top of the list of possible causes of an abrupt change. Finally, the Beers Criteria for Inappropriate Medication Use (AGS, 2012) is an excellent resource for prescribing. These criteria are an easy-to-use list of medications and include those that are potentially inappropriate, drugs that should be used with caution, and those that should be avoided in the presence of certain diseases.
Whether you are an older adult, a family member, or a health care professional, you need to be vigilant about medication use in older adults. Knowledge and coordination of care can greatly enhance well-being and avoid the potentially dangerous consequences of polypharmacy.
References
- American Geriatrics Society Beers Expert Panel (2012). AGS Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. http://americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2012
- Rounds, L., Rappaport, B. & Mallary, L. (2013). Polypharmacy in Senior Adults. American Journal for Nurse Practitioners, 17(1/2), 7-10+.
Our Guest Blogger this week is Linda R. Rounds, PhD, RN, FNP, Professor, UTMB School of Nursing.
Join us for a real-time discussion about questions raised by this essay on Wednesday from 12:00 p.m. to 12:45 p.m. See Discussion and SL tabs above for details. Link to the virtual meeting room: http://tinyurl.com/cjfx9ag.
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