Polypharmacy Management in Older Adults

EBP Topic Selection: Polypharmacy Management in Older Adults

 Polypharmacy Management in Older Adults

Reason for picking the topic

Polypharmacy, which is the concurrent prescription and use of five or more medicines is a rising health concern in older adults. Although polypharmacy might be clinically beneficial in many instances, it is associated with numerous adverse clinical consequences. Older adults with polypharmacy are highly likely to have drug-to-drug interactions and adverse events related to drug use.  Also, polypharmacy is connected with frailty, reduced physical function, cognitive impairment, repeated hospitalizations, and mortality. Evidence demonstrates that polypharmacy has the potential to pose a burden on the lives of older adults and lead to negative feelings. For instance, older adults find it challenging to manage multiple medications, resulting in polypharmacy negatively affecting older adults’ medication adherence and quality of life (Cheng et al., 2023) Polypharmacy Management in Older Adults.

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Young et al. (2023) emphasize that an aging population alongside polypharmacy might result in the prescription of potentially inappropriate medications, which can be both ineffective in treating the patient’s condition and result in a greater risk of experiencing adverse drug events, including drug-disease interaction, and drug-drug interaction, as well as failure to take medications because of heightened medication burden. These factors can in the end lead to adverse health outcomes, including a deterioration in cognitive and health status. As around fifty percent of hospitalizations related to adverse drug events are avoidable, when adverse drug events occur, they might subsequently result in increased hospital admissions. The occurrence of adverse drug events might make a patient be prescribed more medications to treat or prevent these adverse events, further aggravating drug use and burden on patients.

Problem statement

Polypharmacy is a serious clinical problem that affects more than half of older adults in the United States, and is linked with poor outcomes, adverse drug events, and increased healthcare costs.

Etiology of the problem

Multimorbidity, multiple prescribers, and availability of drugs are factors associated with polypharmacy in geriatric patients.  According to Young et al. (2021), old age is associated with an increased risk of an individual having multiple chronic diseases, leading to a higher prevalence of concurrent use of multiple medications.  Hoel et al. (2021) emphasize that the problem of polypharmacy is contributed by numerous factors, including accessibility of medications in herbal stores, in stores, and online; multiple pharmacies, and multiple prescribers.  Polypharmacy Management in Older Adults. Due to the segmentation of health care systems, patients visit numerous health care professionals who lack shared records and unknowingly prescribe interacting or duplicative medications. When pharmacies do not have integrated prescription records, it leaves pharmacists unaware of interacting medications or duplicates that their patients have been prescribed.

Lack of adherence to lifestyle changes is another factor contributing to polypharmacy in older adults. According to Hoel et al. (2021), the prescription of treatments is done to meet desired objectives, though there are strong beliefs that medications treat health problems. For instance, the majority of patients with diabetes are treated with multiple medications, few patients adopt recommended lifestyle activities and changes that could enable them to accomplish goals of treatment with fewer medications.

Epidemiology/Prevalence of the problem

Polypharmacy is common phenomenon in both community and clinical settings, with a high prevalence among geriatric patients in the United States and across the globe. According to Keller et al. (2024), in the United States, the approximated rate of polypharmacy among adults 65 percent for adults sixty-five years and above is 65 percent.  In Europe, approximates of the prevalence of polypharmacy in geriatric patients is between 26 percent and 40 percent, with the prevalence rate of polypharmacy is 49, percent, 42 percent, and 36 percent in India, South Korea, and Australia, respectively. Polypharmacy Management in Older Adults

References

Cheng, C., Yu, H., & Wang, Q. (2023). Nurses’ Experiences Concerning Older Adults with Polypharmacy: A Meta-Synthesis of Qualitative Findings. Healthcare, 11(3), 334. doi: 10.3390/healthcare11030334

Hoel, R. W., Connolly, R. M., & Takahashi, P. Y. (2021). Polypharmacy Management in Older Patients. Mayo Clinic Proceedings, 96(1), 242-256. https://doi.org/10.1016/j.mayocp.2020.06.012,

Keller, M. S., Qureshi, N., Mays, A. M., Sarkisian, C. A., & Pevnick, J. M. (2024). Cumulative Update of a Systematic Overview Evaluating Interventions Addressing Polypharmacy. JAMA Network Open. 7(1), e2350963. doi:10.1001/jamanetworkopen.2023.50963

Young, E. H., Pan, S., Yap, A. G., Reveles, K. R., & Bhakta, K. (2021). Polypharmacy prevalence in older adults seen in United States physician offices from 2009 to 2016. PLoS One, 16(8), e0255642. doi: 10.1371/journal.pone.0255642  Polypharmacy Management in Older Adults