Elderly polypharmacy

Polypharmacy is the taking of numerous dru that can potentially react witli one anotlier. When practiced by tlie elderly, polypharmacy leads to an increase in tlie number of potential adverse reactions. Although multiple drug therapy is nec saiy to treat certain disease stat, it always increases the possibility of adverse reactions. The nurse needs good assessment skills to detect any problems when monitoring the geriatric patient s response to drug therapy. 

Horne R and Weinman J (1999) Patients beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. J Psychosom Res 47(6) 555-567 Kannisto V, Lauritsen J, Thatcher AR et al. (1994) Reductions in mortality at advanced age several decades of evidence from 27 countries. Population and development review 20(4) 793-810 Lazarou J, Pomeranz BH, Corey PN (1998) Incidence of adverse drug reactions in hospitalized patients a meta- analysis of prospective studies. JAMA 279(15) 1200-1205 LeSage J (1991) Polypharmacy in geriatric patients. Nurs Clin North Am 26(2) 273-290 Pitkala KH, Strandberg TE, Tilvis RS (2001) Is it possible to reduce polypharmacy in the elderly ... 

Many different drug classes have shown to cause hypotension and orthostatic reactions and drugs for cardiovascular conditions, psychoactive medicines and polypharmacy, can all have this side effect (Box 5.15). Among the most frequently used drugs in the elderly are diuretics, ACE-inhibitors, angiotensin II antagonists, calcium channel blockers and antidepressants. 

Several of the individual problems and risks increasing and cumulating the risk for morbidity and mortality in the elderly are presented in this book. Each of them is presented in more detail elsewhere. Special attention should be given to patients with severe diseases, polypharmacy, high-alert medications, several prescribers, several acute hospital admissions, and low compliance. It is important to understand that the problems and risks are interconnected. One problem lead to another in a cascade, where the net benefit to harm relation, might be negative. 

Polypharmacy is often a consequence of the cascade of problems. A literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality (Hajjar et al. 2007). The reviewers states that many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring . 

American Pharmaceutical Association, Washington, DC Hajjar ER, Cafiero AC, Hanlon JT (2007) Polypharmacy in elderly patients. Am J Geriatr Pharma-cother 5 345-351... 

The physiological changes and other aspects in the elderly makes this even more complicated. Example of this is decreased stomach acidity decreased motility decreased blood-flow to liver and gastrointestinal tract changed pharmacokinetics and -dynamics polypharmacy swallowing problems bad nutritional status and lack of documentation. 

Elderly are more susceptible to adverse effects of drugs due to decreased physiologic reserves, polypharmacy and co-morbidity. Precribers should therefore always consider whether non-pharmacological treatment may be appropriate before prescribing additional drugs to elderly patients. 

Finally, a good personal drug history often reveals that iatrogenic polypharmacy contributes to ill health, both physical and psychiatric, in elderly patients. Pharmacokinetic and Pharmacodynamic Issues... 

Hanlon JT, Weinberger M, Samsa GP, et al. 1996. A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy. Am J Med 100 428. 

Older The elderly are at increased risk of adverse drug reactions in general due to altered pharmacokinetics and polypharmacy. For example, reactions to halothane, chlorpromazine, flucloxacillin and co-amoxiclav are more common in elderly patients... 

Although it is somewhat controversial, certain personality traits in elderly patients may predispose them to using more medications. " Elderly patients and their physicians may also be reluctant to discontinue medications. Often, patients with these views feel it is necessary to use medications and to obtain more prescriptions each time they visit a physician. This may also tie in with the attitudes of healthcare providers, who may be pressured to prescribe more medications for the patient. Finally, polypharmacy may be common in the elderly because they often borrow medication from family or friends, sometimes because of lack of education about the risks of inappropriate medication use. 

Veehof, L.J.G. Stewart, R.E. Meyboom-de Jong, B. Haaijer-Ruskamp, L.M. Adverse drug reactions and polypharmacy in the elderly in general practice. Eur. J. Clin. Pharmacol. 1999, 55, 533-536. 

Polypharmacy. Elderly patients are more likely to take multiple medications, including both prescription and nonprescription products. Whenever possible, the medication regimen should be simplified. The pharmacist also should consider the extent to which the mode of drug delivery (e.g., pill, patch, or inhaler) may influence adherence. 

A number of factors are believed to increase the risk of drug-related problems in the elderly, including suboptimal prescribing (e.g., overuse of medications or polypharmacy, inappropriate use, and underuse), medication errors (both dispensing and administration problems), and patient medication nonadherence (both intentional and unintentional). The following subsections address suboptimal prescribing and medication nonadherence, the most common problems. 

The Beers criteria were updated recently/ At present, it is not clear what is the best way to measure inappropriate prescribing. Global measures for detecting polypharmacy or unnecessary drug use and underuse of essential medications are needed, as well as additional studies examining drug-disease interactions and other health outcomes. Moreover, we recommend further studies of the predictive validity of evidence-based standards for measuring inappropriate medications in the elderly. 

Montamat SC, Cusack B. Overcoming problems with polypharmacy and drug misuse in the elderly. Qin Geriatr Med 1992 8 143-158. 

Linjakumpu T, Hartikainen S, Klaukka T, Veijola J. Use of medications and polypharmacy are increasing among the elderly. J Qin Epidemiol 2002 55 809-817. 

Electroconvulsive therapy remains the gold standard for the treatment of major depression and a variety of other psychiatric and neurologic disorders (97). Because of the effectiveness and resurgence of ECT, more patients are considered to be good candidates for this treatment option. Overall, these patients are medication refractory and elderly and, thus, are more sensitive to polypharmacy. Additionally, these patients tend to have more coexisting medical problems. 

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