Polypharmacy and the Challenge of Medicine Administration in the Elderly

polypharmacy many medications

Polypharmacy is defined as taking five or more prescription medications daily, and it is most commonly seen in the elderly patient population and long-term care homes (Source). It is problematic because it can lead to adverse drug events (ADEs), decreased physical functioning, and more hospital admissions.

Elderly Population and Medications

Elderly patients:

  • Receive more than 50 percent of all prescribed medications
  • More than 90 percent are on at least one prescription medication
  • In the healthcare system, take six to eight medications
  • Have comorbidities such as hypertension, diabetes, heart failure that require more than one medication already

Pharmacists and nurses remain among the most trusted professions in the United States, and they are also on the front lines of elder care. Here are some things that can be addressed in pharm tech programs and nursing curriculums that include medication administration in long-term care homes.

Factors that Contribute to Polypharmacy

Problems you can’t fix:

  • Increasing age: A typical 65 year old will live to age 83; one in four live until they are 90; and one in 10 will live until 95.
  • Multiple symptoms due to multiple medical problems: Elderly patients usually suffer from a number of chronic illnesses, not just one or two, and those illnesses cause many symptoms.
  • Drug regimen changes: Because of their ever-shifting health issues, medications can change rapidly with little notice.
  • Multiple providers: Elderly patients have many healthcare providers treating them at once, for a variety of things. These providers don’t always talk to one another.

Problems you can fix:

  • The lack of a primary care provider to coordinate
  • Use of multiple pharmacies
  • Hoarding medications
  • Self-treatment
  • Copious prescribing

Reducing the Risk of Polypharmacy

Risk reduction requires organization and education. Health care providers such as nurses and pharmacists, as well as patients and families can keep comprehensive lists of medications, dosages, and reasons for the medication up to date. Patients, families, and caregivers can also be educated on:

  • The name, appearance, effects and purpose of each medication
  • Potential adverse effects and interactions of medications
  • Importance of contacting a healthcare provider about concerns or questions
  • Potential drug-related problems that warrant emergency care
  • Importance of taking medications exactly as provided

With the proper education, organization, and preparation, polypharmacy doesn’t have to be problematic for patients and care givers.

For pharm tech, pharmacy, and nursing programs, stocking up on simulated medications for administration scenarios is a good place to start. See Pocket Nurse’s Demo Dose family of simulated oral meds.

Information for this post came from a presentation by Denise Kreckel, R.Ph. “Polypharmacy: Poly-drug, Poly-Problems” was presented at Strategies: Educational Excellence for Healthcare Providers and Educators 27th Annual Conference at Penn State University. This is part one of a series of posts based on her presentation. Kreckel is from the Centre Volunteers in Medicine in State College, PA.

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