Polypharmacy: Keeping the elderly safe
Polypharmacy is defined as taking multiple medications for the same condition, taking different medications for multiple conditions (multi-morbidity), or taking more drugs than are medically necessary, although there is no consensus on the exact number of unique medications taken concurrently to be considered polypharmacy. The prevalence of polypharmacy in an aging population is significant and continues to grow as innovative therapies to treat diseases are discovered. Some studies say nearly 50% of residents in nursing homes are potentially taking medications for inappropriate use.
There is a direct correlation between the number of medications taken and adverse drug events, drug-drug interactions, and falls (all of which can result in hospital admissions) – and even mortality. Additionally, poly-pharmacy in the elderly is correlated with non-adherence (ambulatory population), functional decline, cognitive impairment, urinary incontinence, and malnutrition. Reducing polypharmacy will have a positive impact on patient outcomes, quality of care and the bottom line of your facility, but where do you start?
Polypharmacy has many proven interventions that are documented and published. Nevertheless, the common thread for success in reducing polypharmacy is a multidisciplinary approach. Nursing staff can both directly contribute to and improve the problem, depending on their level of awareness of signs and symptoms of adverse drug events.
For example, a common side effect of some drugs is constipation, for which a typical knee-jerk reaction is to prescribe a laxative, further increasing the medication burden. Laxatives can also lead to dehydration and electrolyte imbalance in the elderly, placing them at an increased risk of falls. Awareness of the onset of constipation in the resident after start of a new medication could prevent this cascade.
Pharmacist consultants are integral in preventing polypharmacy since they regularly recommend discontinuation, changes, or reductions in medication use as they review and evaluate a resident's medical record. However, if physicians are not engaged, do not respond to, or decline these recommendations, there is a missed opportunity to prevent negative health and economic outcomes.
While polypharmacy requires full engagement of the entire team and a focused attention to the problem, it is also imperative to focus on two critical periods of resident care:
Transitions – Upon admission and discharge, always review a resident's medication regimen and verify all medications are necessary
Change of Condition – Review medication changes first. Is there a documentation of a change in condition in the MDS? Are there any new additions to the medication administration, dosing changes, and/or new drugs added?
In my next post, I will focus on adverse drug events and how to recognize and prevent them.
Sonja Quale, Pharm.D. is the vice president and chief clinical officer at PharMerica Corporation.