By Jacob Brown, Kortney Schmitt, Shelby Sonnega, Sara White
University of Southern Indiana
Individuals with multiple medical problems may be prescribed several medications. Polypharmacy is the use of five or more medications being prescribed and taken by the individual. Problems related to drug interactions between several medications can be minimized with proper education and organization. The purpose of this paper is to provide a background of polypharmacy and to help individuals increase self-advocacy with their medications.
Older adults are more at risk for polypharmacy for a variety of reasons. The process of absorption and excretion of medications is delayed in adults over the age of 65. The kidneys and the liver are responsible for breaking down medications, and have a declining function with age (Perry, 2011). This means that drugs stay in the body longer, and can accumulate in the system leading to drug toxicity. Older adults are also living longer due to medical advancements which mean that they may develop more chronic conditions that require additional medications (Perry). According to Perry, prescribing rates for the elderly population have increased as new drugs become available to treat acute and chronic disease. This contributes to an increase in prescribing rates for the elderly population. Hospitalizations can contribute to the cause of polypharmacy. According Sergi, Del Rui, Sarti, and Manzato (2011), “57.4% of hospitalized patients were prescribed more drugs on discharge than they had been taking one month before admission” (p. 511). Contributing factors to polypharmacy include multiple health problems and communication issues. Lack of communication between the patient and the doctor or healthcare provider can lead to inappropriate drug prescriptions (Rochon, 2016). When discussing their list of medications patients may not recognize the importance of communicating when they take over the counter medications including non-steroidal anti- inflammatory drugs (NSAIDS) such as ibuprofen with their health care provider. NSAIDS have a high risk for side effects in the elderly (Perry). Furthermore, the patient may confuse the dosing of their multiple medications, leading to possible over or under dosage (Rochon).
Polypharmacy has been known to correlate with poorer health outcomes in the elderly population. One of the associated poor health outcomes is an increase in falls. Drugs such as diuretics that remove excess fluid, benzodiazepine derivatives that reduce anxiety, and anticholinergics that can be used for common symptoms of stomach or urinary issues are known to increase fall risk, especially if they are taken together as prescribed (Sergi et al., 2011). Older adults are at risk of several adverse effects often worsened by some medications which include constipation, malabsorption or impaired digestion, liver toxicity, upset stomach, bleeding from gastrointestinal organs, and diarrhea (Perry, 2011). The prescribing cascade is another issue related to polypharmacy. This is when a side effect from a medication is treated with another medication (Rochon, 2016). The cascade can occur when a patient is admitted to a hospital for an adverse effect from their medication, and the health care provider adds more medication (Sergi et al.). In addition to causing physical problems, polypharmacy can also lead to financial concern due to the expense of certain medications and being on so many medications. Polypharmacy also puts patients at risk of medication errors as older adults can become confused on the dosage and the particular time of day to take the medication (Sergi et al.). Confusion is another possible side effect or adverse reaction from taking multiple medications properly or improperly (Rochon).
Some medication prescriptions cannot be avoided, but some interventions can help minimize the risk of adverse effects of polypharmacy. An important tool to monitor the potential for high-risk medication for the elderly population is the Beer’s List. This tool identifies medications that are known to cause adverse effects (Rochon, 2016). While some drugs may be unavoidable, the Beer’s List can be used by healthcare providers as a list of drugs that have the potential to cause adverse effects. Organization is critical to managing complicated and demanding medication regimens. One organizational tool is a pill divider box, and is useful for anyone taking several medications, to organize all medicines in one daily container identified for the day of the week (Perry, 2011). In addition to a pill divider box, another tool is a medication list. The medication list allows the patient to identify the name, time, route, dosage, and frequency from a table on a piece of paper. This tool is also useful to give to the healthcare provider or pharmacist in order for them to accurately review the medications a patient is on and make decisions or adjustments as necessary (Perry). An important risk factor for adverse drug reactions is underreported medications such as herbals and vitamins, which may not be acknowledged as medications by the patient. By informing the healthcare provider or prescriber of these medications, drugs that interact negatively with herbals and vitamins can be avoided (Perry). One way to minimize drug prescriptions is for the patient to undergo medication reviews with the physician and ask if the particular drug is still needed (Sergi et al., 2011). This can also apply to dosages as well. One of the most important concepts for patients to know is what side effects to look for and to notify the physician about any problematic or unexpected side effects. For example, anticholinergics medications can cause memory impairment, confusion, hallucinations, dry mouth, blurred vision, constipation, nausea, urinary retention, impaired sweating, and tachycardia (Rochon). By informing the healthcare provider, the dosage can be adjusted and adverse effects minimized.
The use of multiple medications by older adults is often needed for various reasons related to the aging process or chronic disease. Polypharmacy puts older adults at greater risk of the adverse effects of medications. Lack of communication with the healthcare provider regarding medications including over the counter medicines, herbals, and vitamins can lead to poorer health outcomes, more adverse drug reactions, drug to drug interactions and medication administration mistakes in older adults. It is recommended that patients have an understanding of medications and have a regular review of all medications being taken with the healthcare provider to help eliminate taking unnecessary medications, vitamins or herbals.
Jacob Brown, BSN Student
Kortney Schmitt, BSN Student
Shelby Sonnega, BSN Student
Sara White, BSN Student
Pam Thomas, MSN, RN, CCRN
Charlotte Connerton, EdD, RN, CNE-BC
University of Southern Indiana College of Nursing and Health Professions
Sergi, G., De Rui, M., Sarti, S., & Manzato, E. (2011). Polypharmacy in the elderly can comprehensive geriatric assessment reduce inappropriate medication use? Drugs & Aging. 509-518. http://dx.doi/10.2165/11592010-000000000-00000
Perry, M. (2011). The problem of polypharmacy in the elderly. Nurse Prescribing. 9(7), 347-349. Retrieved from http://www.nurseprescribing.com
Rochon, P. (2016). Drug prescribing for older adults. In K. Schmader & L. Parker (Eds.), UpToDate. Retrieved from www.uptodate.com