According to Fulto and Allen (2005), polypharmacy is “the use of medications that are not clinically indicated.” Older people in particular are vulnerable to polypharmacy due to their advancing age, complexity of disease and due to the availability of over the counter drugs. As the older population seek out treatments, the risk of acquiring multiple layers of drug therapy also increases which then leads to several complications such as drug interactions and adverse reactions to drug therapy. In the United States alone, the older adult make up 13% of the population, with 30% comprising the population that takes several medications. As Baby boomers advance in age, it is estimated that this age group will be 77 million in number, thus having several implications on the health care system.
Several practices and methods can be utilized in order to prevent and manage polypharmacy in the older adult. These includes:
1. Understanding the aging process and its effect on the metabolism of drugs
The older adult may experience intolerance to certain medications as aging greatly affects the absorption, distribution, metabolism and elimination of drugs (Meyer, 2003). They may be more prone to experience side effects of medications, thus affecting their well-being and quality of life. It is therefore essential that nurses are armed with adequate knowledge in order to recognize and prevent polypharmacy
2. Proper patient education
Patients should always be informed of the medications that they are taking. In the older adult, it is important to detail out the purpose of their medication as well as clear instructions on when and how to take their medication. Poor understanding on the patient’s part could lead to more problems and complications later on. It is important that health care workers verify patient understanding of their medication regime. It may also be necessary to provide written instructions, particularly for the older population. Instructions and further information may also be discussed with the patient’s relatives or carers as appropriate.
Some helpful points to teach patients include:
Use the same pharmacy to get prescribed medications. This is to ensure that pharmacies have all the information about current drug regiment. In addition, pharmacies often have systems in place that will alert the pharmacist of possible drug interactions and adverse effects.
Read medication labels prior to taking it. Request labels with large print if with vision problems
Never take alcohol with any medication. Consult a healthcare provider if taking in alacohol regularly.
Contact a healthcare professional immediately if side effects develop from medication use.
Always check the expiry of medications
Never combine ay medication in the same container to prevent interaction
Do not abruptly stop taking a medication or change the dosage without prior consultation with your doctor
Avoid sharing medications or take something that is merely given or advised by someone other than a healthcare professional
3. Regular review of Medications
Regular review of medications can help decrease number of medications taken by the older adult and also serves to keep costs down. As medications also have side effects, it is important to recognize these in order to avoid the prescription of another drug to cure the side effect. Patients should be encouraged to bring an updated list of the medications they are currently taking, both prescription and over the counter medications.
4. Ensuring coordination among healthcare agencies
Hospitalization as well as the older person’s movement from his residence to a care home or vice versa can serve as a factor to polypharmacy. Communication across various levels of care, such as from the acute setting to secondary care should remain constant to ensure continuity of care.
5. Promote alternative measures
Doctors, Nurses and other health care workers can educate patients on alternative methods to manage some common complaints. For example, constipation can be managed initially by increasing the intake of fiber and eating fruits that have laxative effects rather than starting to take an oral medicine. Identifying health risks is also essential in order to promote health and prevent disease.
Fulton, M. and Allen, E. (2005) Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practitioners, 17, 123–132.
Hale, W.E, May, F.E, Marks, R.G, and Stewart, R.B (1987). Drug use in an ambulatory elderly population: a five-year update. Drug Intell Clin Pharm, 21: 530–535.
Meyer BR (2003) Clinical pharmacology and ageing. In: Grimley Evans J, Franklin Williams T, Lynn Beattie B, Michael J-P, Wilcock G, eds. Oxford textbook of geriatric medicine, 2nd edn. Oxford: Oxford University Press, 127–136.