With the elderly population living longer, the rise of polypharmacy is becoming more common. Polypharmacy, the state of being in more than 5 medications causes high risk in the health of the patient and consequently becomes a huge concern for medical practitioners (Golchin, Frank, Vince, Isham & Meropol, 2015). Polypharmacy is common among the elderly people especially because of high morbidity factors. As a result, it becomes medically necessary to be on multiple medications, although it is not advisable especially given the high risk the patient is put into. The question becomes does the benefits outweigh the consequences? It is important to understand these risks and possible interventions to prevent, treat and respond to polypharmacy risks in order to improve patient outcomes.
Among the risk associated with polypharmacy are reactions between drug to drug reactions and increased risk of morbidity. Approximately 40% of the older adults are on multiple prescription drugs, while half of these are at a high risk of experiencing the risks associated with polypharmacy (Rossi, Feske, Shaffer & Kreutzer, 2017). Reaction to drugs can cause effects such as allergic reactions and other serious adverse effects that can be fatal (Azhagesan, 2017). Also, drugs may react with each other resulting in one having a greater effect than the other, and possibly hindering it from the intended action. Morbidity is the ultimate and most unprecedented risk as death may occur on the patient following immunity weakening.
As a health concern, practitioners need to respond to this issue. The first response is to examine the patient’s accurate medical history upon any given discharge. This is important in examining previous medications and how they fared well with the particular patient. This also helps to inspire the most accurate medication (Rossi, Feske, Shaffer & Kreutzer, 2017). Secondly, the medical practitioners need to reconcile medications given to the patient (Azhagesan, 2017). This helps to prevent the risk of drug to drug interactions, while adhering to early intervention to help to prevent or deal with medical issues.
Risk Factors for Polypharmacy
Polypharmacy entails taking of 5 or more medicines. Generally, polypharmacy in the elderly occurs because of three factors: demographic factors, health factors, and access to healthcare. It is more common among older patients and has potential harms such as drug interactions and drug toxicity. Polypharmacy is an area of concern for elderly because of several reasons. Elderly people are at a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with ageing; this risk is furthermore exacerbated by increasing the number of drugs used. Polypharmacy is linked to increased risk of adverse drug events in older people due to increased risk of drug interactions, lack of adherence to medication regimes, susceptibility of older people to side effects of medications, and physical changes related to ageing causing difficulties in taking medications as prescribed. One of the risk factors is frailty. Patients who are frail are more likely to be having many health conditions that can contribute to excessive polypharmacy. Another risk factor is multimorbidity (Card, 2016; Ersoy, 2018). Patients who have many chronic conditions may be have to take 5 or more medicines to manage their conditions. Obesity is another risk factor. Obese people may have risk factors for many health conditions such as diabetes, heart disease, and high blood pressure, among others (Ersoy, 2018). These conditions may make them to take many medicines to manage them, therefore resulting to polypharmacy. In the elderly, disorders that occur as a result of ageing, frequently require treatment, resulting in increased use of medications. Polypharmacy is common among the elderly and although it can be therapeutic in nature, is linked to adverse events such as falls.
Interventions to prevent polypharmacy and its complications
A nurse practitioner is central to the administration of healthcare services. The nurse can play certain roles to prevent polypharmacy and its complications. One intervention may entail assessing for drug-drug interactions. If there are interactions, there may be a need to eliminate some medicines. Another intervention may include reviewing dosages. The effects of the medicines may be due to excess dosages. The reviewing of dosages can lead to a reduction in the number of medicines that one takes. Another intervention is eliminating duplicate medications (Johansson, 2017). Some medications may serve the same purpose; and therefore, it is necessary to eliminate some to reduce the burden on the patient. Exploring non-pharmacological approaches may also be necessary. For instance, if a patient has depression or anxiety, use of psychotherapy and exercise may be a useful alternative to medicines and therefore reduce the number of medicines that one takes.
Indeed, polypharmacy in which patients take several medicines to an extent that they result in complexities is a common experience among the old people. Such a situation is as a result of particular aspects which is discovered can solve the issue. The common risk factors for polypharmacy among the older individuals are gastric disturbances as well as gastrointestinal diseases that induce a lot of adverse reactions which make patients opt to taking gastrointestinal drugs. The intake of such drugs them result in cascading of treatments and increment in DDC. Additionally, painful conditions which the older adults suffer including arthropathic, chronic, and neuropathic pain. According to Word Health Organization (2019) chronic pain is related with behavioral and somatic comorbidities encourages the old adults to consume excess analgesic. Indeed, risk factors such as the ones mentioned above trigger the increased cases of polypharmacy.
As a Nurse Practitioner, I would proactively teach the community especially old patients about sustainable and suitable medication as well as lifestyle. According to WHO (2019) unhealthy lifestyle causes multimorbidity among many patients, hence educating the ole people on healthy foods, proper health care, and housing as well as exercising helps reduce polypharmacy and its effects. The second intervention is to involve the patients into understanding the effect of using too many medications, reporting side effects immediately they happen, and using medication in the correct manner. Molokhia & Majeed (2017) Opines that involving patients in the process of medication, monitoring them as they start and continue using the medication, as well as informing them on the right way to take drugs and report on impacts serves in reducing risks of polypharmacy. Therefore, the two interventions would suit me well.
Risk Factor for Polypharmacy
Polypharmacy may lead to comorbidities mostly to elderly people since its strongly related to age. Most of the aged people suffers from multiple illness at the same time leading to the taking more than one medication to cater for different sickness (Cantlay, Glyn, & Barton, 2016). Patients with multiple comorbidities have a high risk of polypharmacy since treating the patient with various illnesses has become a general practice in the health sector. In addition, most of the clinical officer’s focus on the single disease at a time, excluding patients with multiple conditions.
Polypharmacy increases the risk of poor behavior and misunderstanding on medication to the patient. Most of the patient lack proper knowledge of drugs and reliable on available information or experience. This led to duplication or unnecessary medication prescribed by medical staff who have no previous medical history of the patient. The patient also accesses medication from multiple providers that do not know his other health condition.
Intervention to Prevent Polypharmacy
First is through identify the indication strategy that should be implemented by any therapist and physician. The approach involves identification or diagnosis before the medication is given out to avoid the increased case of misappropriating prescriptions in healthcare facilities (Fasipe, Akhideno, Ibiyemi-Fasipe, & Idowu, 2018). It also the role of the patient to ensure the information given is clearly communicated and in the direction of use.
Another method is the integration of START (screening tool to alert the doctor to the right treatment) technology in health care facilities. The technology provides the physician with an opportunity to evaluate and discontinues any prescribed medication that poses a risk to polypharmacy.
Polypharmacy refers to the use of more than one medication by a patient. The exact number of medications that define polypharmacy vary from one person to another and ranges from five to ten drugs. There are various risk factors associated with the condition. The first one is age. Polypharmacy is common in old people. The elderly are more susceptible to experiencing the condition since they have multiple diseases which require varying prescriptions. The elderly are also at risk since their bodies have high chances of experiencing drug events as a result of metabolic changes and a reduction in drug clearance capabilities (Abdulraheem, 2013).
According to Slater, White, Venables, & Frisher (2018), another risk factor associated with polypharmacy is poverty or lower wealth. People from lower social classes tend to use over the counter drugs to treat themselves due to lack of funds to take them to hospitals. As a result, they take more than one medication for their conditions. Obesity is also believed to increase the risk of polypharmacy. Obesity is usually associated with a series of chronic heart diseases such as hypertension. Therefore, obese people use multiple medications to treat various diseases.
The first intervention towards preventing polypharmacy involves drawing from palliative care. The intervention is mostly applicable in very old people, and it entails discontinuation of drugs being administered on the patient. Another method entails conducting medication training during transition care. An example of a transition case is discharging a patient. Duplicate medications also need be to eliminated (Dagli, & Sharma, 2014). The last method entails assessing a patient for the presence of drug-drug interactions before administering any medication. Therefore, as a practitioner, the interventions which I would take to prevent polypharmacy include training patients before they are discharged and assessing them for drug-drug interactions before administering medications.
MayleePolypharmacySome of the definitions concerning polypharmacy that can be encountered in my readings can be more than one definition aspect. The first description of polypharmacy is the utilization of numerous pharmacies, which is a chief public health concern. This happens as the multiple prescribers in the industry, the ever readily available of supplements, and the use of OTC medications are some of the experienced challenges affecting the prescription for the aged population ( Chamberlain College of Nursing, 2018). Secondly, numerous prescribers, as well as care providers, the use of OTC drugs, the cost adherence, the availability of supplements as well as the herbals, are still problems affecting the prescriptions for the adults (Terrery & Nicoteri, 2016). Moreover, the use of several medicine drugs is what is referred to as polypharmacy, which usually affects the older population experiencing multi-morbidity, results as one or more medicine drugs can be employed as a therapeutic modality to treat each condition experienced (Masnoon, Skakib, & Caughey, 2017).The self-medication is a risk factor which contributes to the polypharmacy in most of the cases. The primary rationale here is evidenced based on that most of the patients usually buy medicine from the nearest local places as they do self-prescriptions and purchase, and this increases the risk factors of polypharmacy. Moreover, due to the rising status of the economy and the escalation of the cost of medicinal drugs the patients are often like to use the medicines that had been prescribed for them in the past and this enhances the risks of polypharmacy as a result of the self-medications (Maher, Hanlon, & Hajjar, 2014),The aspect of chronic comorbidities is a risk factor that results in the use of polypharmacy. For example, if the patient has been diagnosed with conditions such as diabetes, cancer, dementia, cardiorespiratory illness, infectious diseases, these patients are likely to be subjected to polypharmacy. Sometimes, when patients have different care providers with separate chart sheets, they are likely to subject the patient to polypharmacy (Maher, Hanlon, & Hajjar, 2014).Some of the interventions that I can take as nursing practitioner is enhance a comprehensive review of the patient treatment sheet to avoid an element of medication duplicate which might occur during the transmission of the patient from one facility to another one or even correctly check the information given to the patient by the chemist to avoid polypharmacy issues. The brown bag review technique is the strategy where the patient is encouraged, carrying all medical history to allow the comprehensive review to prevent the element of subjecting the patient into polypharmacy (McGrath et al., 2017). Another intervention strategy is to create a thorough follow up with the patients. The planning aid at the time of doing a prescription of medication as it provides a complete developed plan to monitor and assess the patient regularly. The comprehensive follow up method enables the patient to understand the effects and symptoms that may results due to medication withdrawal as it provides the necessary, which can cause the return of the condition if the medication is not taken as per the prescription.