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Polypharmacy in the older adultTrina SkinnerStenberg CollegePolypharmacy in the older adultPolypharmacy is a growing concern in the healthcare industry, particularly in relation to a dramatic increase in the population of older adults living with a number of chronic illnesses that is predicted to remain on the incline in years to come. Polypharmacy can be defined as “the use of a number of different drugs, possibly prescribed by different doctors and filled in different pharmacies, by a patient who may have one or several health problems” (Mosby, 2009). Psychiatric nurse’s function as a vital part of the process in reducing the incidence of polypharmacy, as often times this condition may be perceived as a possible psychiatric disorder as many of the symptoms of evident in polypharmacy are also indicative of psychiatric diagnoses. In order to find resolution to this serious health concern, one must first understand what constitutes as well as causes incidence of polypharmacy, obtain information and education on possible indications and effects, as well as focusing on ways to decrease the risk and occurrence of polypharmacy through adopting more holistic health based measures.Understanding polypharmacy and some common causesIn order to address the growing concern and increase awareness of the incidence of polypharmacy, one must grasp a firm understanding of what polypharmacy is and the circumstances that lead to its development. The dynamics of polypharmacy involve not only the use of various drugs for various diagnoses. One must also consider medications that are contraindicated in the older adult, as well as medications that may be deemed inappropriate or those that are duplicated or altogether unnecessary. According to Ramage-Morin, (2009), “Concurrent use of five or more medications was reported by 53% of seniors in institutions and 13% of those in households” (p. 5). Two serious concerns related to polypharmacy in the older adult are the inevitable increased risk of medication interactions as well as high potential for adverse drug events to occur. Adverse drug reactions and adverse drug events which we have established are one of the major concerns related to polypharmacy, can vary from minor inconvenience to death, including innumerable health complications in between. As cited in Touhy, Jett, Boscart, & McClearly (2012), “It is estimated that 3 to 36% of older adults are prescribed at least one inappropriate prescription a year” (Robertson & MacKinnon, 2002). This statistic is alarming and I would hope directs focus to the serious need to reassess and integrate our current healthcare model to reflect one based on medication prescription/dispensing maximizing therapeutic drug effects, minimizing the risk of drug toxicity and invoking more personal responsibility and accountability of healthcare professionals to monitor potential risk factors for polypharmacy with assiduousness. There are many reasons why older adults are susceptible to the use of multiple medications, some which include “comorbidity, multiple prescribing physicians, inappropriate prescribing, access to different pharmacies, as well as self-medication with OTC [over the counter] and alternative products” (Ramage-Morin, 2009, p. 6). It is important to bear in mind that regardless of the reason, older adults taking multiple medications are at an elevated risk of experiencing adverse drug events (ADE’s).Education on recognizing indication and possible effects of polypharmacyObtaining reliable information and education on indications and potential effects of polypharmacy is paramount to reducing the occurrence of this condition. Providing effective and appropriate nursing interventions are necessary to recognize and possibly reverse the effects of polypharmacy may have on a client. As cited in Touhy, et al., 2012, p.233-4 “One of the most troublesome ADRS for the older adult is medication-induced delirium and confusion. Polypharmacy with several psychotropic medications that have anticholinergic actions is perhaps the greatest precipitator of delirium as an adverse reaction” (Lieberman, 2004). Healthcare professionals should be well educated in which medications in the older adult population are most likely to cause adverse drug events and adverse drug reactions (ADEs/ADRs). Some of the most common medications that lead to adverse drug reactions in older adults include, “cardiac medications, diuretics, non-opiod pain relievers, hypoglycemic agents, and anti-coagulants” (Touhy, et al., 2012, p. 232). It is important for nurses’ as well as all healthcare providers involved in the administration of medication to thoroughly understand the process of pharmacokinetics. It is necessary that healthcare providers adopt special consideration for the inevitable anatomical and physiological alterations throughout all body systems that occur as a result of aging. The way an older adult may absorb, distribute, metabolize, and excrete medication varies considerably as the client ages. It is also paramount that the healthcare provider understands the natural process of physiological change that an aging adult goes through in relation to the effects these changes will have on the client’s ability to tolerate any and all medications prescribed to them or self-administered OTC medications and natural remedies. Some potential effects or indications of polypharmacy include “causing secondary morbidity from unnecessary or inappropriate medicines and drug incompatibility. Problems can also occur when patients have a poor understanding of the purpose of their medicine regime and how to take their medicines” ( Bretherton, 2003, p. 54). Finally, Ramage-Morin, 2009 explains that “Prescription medications, over-the-counter (OTC) products, and natural and alternative medicines are widely used in Canada, especially by seniors. But while medications play an important role in health care and disease management, their use is not without risk” (p. 1).Reducing the incidence of polypharmacy through the implementation of holistic health measuresBy gaining a thorough understanding and educating oneself on concepts of holistic health and well being, psychiatric nurses and the healthcare team as a whole can utilize specific holistic based healthcare models in order to decrease the incidence of polypharmacy in the older adult population. Holistic health may be thoroughly defined as “a concept in medical practice upholding that all aspects of people's needs, psychological, physical and social should be taken into account and seen as a whole” (Wikipedia, 2012). In no way is this paper intended to encourage the notion that holistic health and wellness measures are an effective substitute for medication. Rather, some methods of holistic health practice are discussed as a possible resolution in reducing the occurrence of polypharmacy if such techniques are used in conjunction with medication. The effects of a variety of chronic illness can be improved through various forms of holistic health practice. Some examples include, and by no means is this list exhaustive, various forms of yoga, including breathing exercises and meditation, accupuncture/accupressure, massage, bio-feedback, hypnosis, infrared sauna, natural diet and herbal supplements, and massage therapy to name a few (Wikipedia, 2012). The client must exercise caution in implementing any herbal remedies and/or nutritional supplements to aid in the management of chronic illness, for pain management or otherwise, thorough research and close communication with a trusted medical doctor is paramount in managing one’s health regimen safe and effectively. We live in a day in age where older adults or their advocates in situation where they can no longer make decisions about their healthcare themselves must take on a certain level of responsibility for their own health and disease management. Clients, especially older adults at risk of falling victim to polypharmacy must be more proactive in educating themselves on their diagnoses, the medications being prescribed to them, maintaining a healthy rapport with their GP, in which they do not feel intimidated asking questions to further understand. Too often the older adult trusts the word of his/her physician without question; we live in a day in age where this is no longer possible, it is imperative that clients or advocates of clients, such as family members or psychiatric nurses be proactive in ensuring regular medication reviews (preferably every three months) and pay close attention to changes in physiology or cognition that could be related to an incidence of polypharmacy. “Reducing adverse drug events in the elderly can be achieved by making precise diagnoses and by treating medical conditions according torecommendations strictly based on the specific literature. When extrapolating from studies ofyounger patients, physicians should consider the physiology of aging, as well as ethical issues relevant to the elderly…Proposed lists of hazardous medication have limitations. Respecting the individual needs of individual patients is the preferred approach” (Brazeau, 2001. p. 94).In conclusion, polypharmacy is an ongoing health concern that is only becoming more frequent and detrimental with the increase of the older adult population. The entire interdisciplinary team in a healthcare facility is responsible for preventing/recognizing and rectifying situations in which cases of polypharmacy are both suspected or confirmed. Psychiatric nurses play a pivotal role in consideration of polypharmacy in the older adult as often times symptoms of polypharmacy may present themselves and be dismissed or misdiagnosed as effects of various psychiatric disorders. Through proper understanding of the essence of polypharmacy and possible causes, adequate education and reliable information regarding the recognition of indications and effects, and introspection as well as implementation of potentially useful holistic health measure to reduce the occurrence of polypharmacy, perhaps the health care community can support each other in strengthening the process of reducing and resolving incidence of polypharmacy in the older adult population. (Brazeau, 2001. p. 94).ReferencesBrazeau, S. (2001, August). Polypharmacy and the elderly. The Canadian journal of CME, 85-94. Retrieved from , A. (2003, April 29). Polypharmacy and older people. Nursing Times. Net, 99 (17), 54. Retrieved from health. (2012, September, 21). Retrieved from , (2009). Polypharmacy. Mosby’s medical dictionary (8th ed.). Retrieved from , H.A. & MacKinnon, N.J. (2002). Development of a list of census-approved clinical indicators of preventable drug-related morbidity in older adults. Clinical Therapeutics, 24, 1595-1613.Ramage-Morin, P.L. (2009, March). Medication use among senior Canadians. Statistics Canada: Component of Statistics Canada Catalogue no. 82-003-X Health Reports. 20(1), 1-9. Retrieved from , T. A., Jett, K. F., Boscart, V., & McCleary, L. (2012). Ebersole and Hess’ Gerontological Nursing & Healthy Aging ................
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