image by: PoKUS: An Advocacy on Polypharmacy Knowledge, Understanding, and Safety
While news reports focus on an epidemic of opioid abuse among young adults, another totally legal and usually hidden drug epidemic is occurring at the other end of the age spectrum: the fistfuls of remedies — both prescription and over-the-counter — taken by older adults.
According to the American Society of Consultant Pharmacists, people aged 65 to 69 take an average of 15 prescriptions a year, and those aged 80 to 84 take 18 prescriptions a year. And that’s in addition to the myriad over-the-counter drugs, herbal remedies, vitamins and minerals they may take, any of which — alone or in combination — could cause more problems than they cure.
Among people over 65, 44 percent…
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The idea of dropping unnecessary medications started cropping up in the medical literature a decade ago. In recent years, evidence has mounted about the dangers of taking multiple, perhaps unnecessary, medications.
Older adults often take more medications than they need, or than is safe. Increasingly, geriatric experts and their patients are exploring the benefits of “deprescribing.”
Most of the attention has focused on just one side of the equation — prices. With politicians and advocates on both sides of the aisle vowing to lower drug prices, few people are talking about Americans being overprescribed medications, which not only adds to the cost of drugs but also harms millions of Americans each year.
“We spend an awful lot of money and effort trying to figure out when to start medications,” Dr. Alexander said, “and shockingly little on when to stop.”
There is nothing new about overprescribing and the inevitable polypharmacy, which the pharmaceutical industry is not exactly eager to discourage. It has been a problem for decades. But the causes are mostly nothing to do with the GPs themselves.
Polypharmacy often means higher health care costs and more drug interactions. Patients are more likely to miss medications or stop taking them altogether. Sometimes, physical activity diminshes; falls, cognitive impairment, malnourishment and urinary incontinence increase; there may be less ability to do daily tasks. Those on five or more medications have a much higher incidence of having an ADE – an adverse drug event – compared to those using fewer meds.
Polypharmacy has been and always will be common among the elderly population due to the need to treat the various disease states that develop as a patient ages. Unfortunately with this increase in the use of multiple medications comes with an increased risk for negative health outcomes such as higher healthcare costs, ADEs, drug-interactions, medication non-adherence, decreased functional status and geriatric syndromes.
It's a common problem for many older adults. You may have more than one doctor and each prescribes a different drug for a different illness. Before you know it, you're taking multiple medications and start feeling tired, dizzy or nauseous. Your doctor interprets that as a new symptom for a new disease and prescribes yet another drug.
More is not always better, said the report. Doctors tend to add new tablets each time an elderly person develops another health condition, but without stopping the old ones.
Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one. Patients may be prescribed medicines that are unlikely to help, potentially harmful, or misaligned with the person’s health goals. Polypharmacy also creates a tremendous burden for patients and their families
The problem occurs when drug-induced side effects are viewed as a new ailment and treated with yet another drug that can cause still other side effects.
Health-care professionals are screening patients to cut out ineffective medicines and avoid risky combinations
Many of these supposed remedies are unnecessary or used incorrectly and can result in distressing and even dangerous side effects. For example, taking aspirin or a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen could increase the risk of bleeding in patients on a prescribed anticoagulant like coumadin.
The Canadian Deprescribing Network is dedicated to raising awareness of medication safety, deprescribing and safer alternatives to risky medications.
Optimizing medication use...
PoKUS is an advocacy movement by Student Nurses of RLE1A of 3NUR1 from UST College of Nursing. We aim to supply the necessary information to fill in knowledge gaps with regard to the dangers of polypharmacy.
The goal of the US Deprescribing Research Network (USDeN) is to develop and disseminate evidence about deprescribing for older adults, and in doing so to help improve medication use among older adults and the outcomes that are important to them.
Polypharmacy is defined as the use of multiple medications by a patient, with 5–10 medications usually accepted as the cutoff.