Polypharmacy in the Elderly - Alabama State Nurses ...€™s Role in Polypharmacy •Be aware of sudden mental, physical, or emotional changes •Ask about challenges taking medications-

Polypharmacy in the ElderlyLynn G. Brown, DNP, RN-BC, CNE

FACES April 2017

The presenter does not have an actual, potential or perceived conflict of interest.

Learning Outcomes

• Discuss two consequences of polypharmacy

• Discuss the nurse’s role in addressing polypharmacy

Definition

• Polypharmacy, the use of five or more medications at one time

• The nurse’s role in education, care coordination, communication, and regular medication reconciliation is vital to improve outcomes

• Adults 65 and older compose 13% of the U. S. population yet account for more than 1/3 of overall outpatient spending on prescription medications

• A study of several nursing homes found at least one inappropriate medicine ordered for 50% of occupants

Aging Population

• By 2050, the population age 65 and over in the US is expected to reach 83.7 million, almost double 2012 numbers.

• The oldest-old (ages 85 and older) is estimated to grow from 5.9 million in 2012 to 8.9 million in 2030.

Physiological Changes in Older Adults


• Physically smaller due to decreased muscle mass, decalcification of bones, and degenerative joint changes.

• Cardiac output decreases

• Percent of body fat increases, amount of body water decreases


• Absorption, metabolism, and excretion rates decrease

• Kidney mass and renal blood flow decline-adults have 50% fewer nephrons by age 80

• Reduced liver function

Causes of Polypharmacy

Two or more chronic illnesses are present in 2/3 of person over age 65

Multiple pharmacy use - the concurrent use of two or more pharmacies in a year

Causes of Polypharmacy

Self diagnosis - use of over the counter (OTC) medications, herb supplements, and medications borrowed from friends and family members

Consequences of Polypharmacy

• Increased risk of Emergency Department visits

• Adverse Drug Reactions


• Increased risk of a prescribing cascade, a new medicine given to treat an adverse reaction due to the incorrect reasoning that a new medical condition has developed

• With the initiation of each new medicine, the risk of an ADE intensifies: 15% with 2 medications, 58% with 5 medications.

• Older adults taking 7 or more medications, the risk of ADE is 82%.


• Poor medication adherence


• Financial costs


• Increased risk for falls and associated injuries

• Decline in functional outcomes

Screening Tools

• Beer’s List

• STOPP - Screening Tool for Older Persons’ Potentially Inappropriate Prescription

• START - Screening Tool to Alert Doctors to the Right Treatments

Nurse’s Role in Polypharmacy

• Be aware of sudden mental, physical, or emotional changes

• Ask about challenges taking medications-confusion regarding scheduling, cost, swallowing


• Assess medications at each visit, prescription and non prescription

• Encourage use of a single pharmacy


• Identify all healthcare providers

• Monitor for ADEs and consider a new sign or symptom could be drug related

Summary• Aging generates some predictable

physiological changes

• The number of older adults with conditions necessitating multiple medications is escalating

• Polypharmacy has critical negative consequences for older adults

• Nurses play an important role in educating, monitoring, and advocating

Questions

ReferencesAlpert, P.T. & Gatlin, T. (2015). Polypharmacy in older adults. Home Healthcare Now, 33, 524-529.

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References (cont’d)Kuo, M., Jeng, C., Chen, C., & Jian, W. (2014). Profile of elderly with multiple physician visits: Advocacy for tailored comprehensive geriatric

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Polypharmacy in the Elderly - Alabama State Nurses ...€™s Role in Polypharmacy •Be aware of sudden mental, physical, or emotional changes •Ask about challenges taking medications-