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The use of multiple medications, whether it be for preventive…

The use of multiple medications, whether it be for preventive measures or to treat an acute process has increased significantly over the last 20 years. In the geriatric populations, “polypharmacy has increased from 12.8% to 39.0% (Martinelli, PharmD, BCCCP, 2021, p. 3). Due to advancing age, there are multiple components that further the effects of polypharmacy. These include a decrease in creatine clearance, decrease muscle mass, increase body fat and a decrease in overall liver function (Martinelli, PharmD, BCCCP, 2021). In the case of Anne, she states her difficulty in tasting her food. This could be caused by a decrease in sensitivity of taste buds as you age or a side effect of a medication she is taking. In turn, she has lost weight and the dosages on her prescriptions may not have been adjusted and the potential for adverse effects is high. Nutritional deficits by only consuming cereal will decrease the overall vitamins and minerals she takes in which can also interfere with how medications are metabolized. For Matilda, she is at an extremely high risk for polypharmacy. After her fall, she stated she doubled up on pain medication which increases her risk of overdose and hepatic/renal toxicity, especially given the likelihood of her potential dehydration from laying on the ground for several hours. Due to limited funds, sharing prescriptions is common although taboo. The geriatric population runs on fixed income with “Medicare cost consuming approximately 20% of beneficiaries income” (Warshaw, MD et al., 2022, p. 12). Eliminating or decreasing dosages of medication is priority and potentially offering Matilda a non-opioid prescription to prevent her unnecessary harm.

Legal and Ethical implications for polypharmacy may pertain to prevention medication that has not been studied in older adults. Studies that demonstrated medication benefits for prophylactic use have not been studied in patients ages 65 and older and who suffer from comorbidities. (Warshaw, MD et al., 2022). The adverse effects of a drug cannot outweigh the benefits of prophylactic use. Often prescriptions are based off protocol and the pressure of upholding those rules. Even though their intentions are good, they tend to “engage more readily with mandatory protocols than with the overall situation and existential concerns of the older persons” (Swinglehurst, MA & Hjorleifsson, 2018, p. 114).

It is important for the elderly population to maintain a certain quality of life and autonomy that is determined by the individual. Polypharmacy is detrimental to this effort due to adverse effects, drug-drug interactions, and financial burdens placed on the elderly. The primary means of solving this problem is systematic and routine reviews performed on patient’s medication regimens. There are several protocols that exist to assist with this effort. This review must ensure that medications are necessary, effective, and affordable. The review needs to retain a patient-centered approach and align with the patient’s quality of life goals. This review needs to occur frequently as the elderly can have life-changing events such as falls or cardiovascular events that can suddenly change what their goals and focus is for their quality of life (Mair et al., 2020).

Medications tend to be more effective in producing their desired effects with minimal adverse effects when taken as prescribed. Medication adherence bares a small but significant correlation improving the quality of life for the elderly population (Silavanich et al., 2019). This is more evidently seen in patients managing chronic diseases. Developing strategies to ensure medications are prescribed in simple methods for easy administration keeping in mind any physical or mental barriers for adherence such as dysphagia or dementia. One of the greatest reasons for nonadherence to medication is the patient’s belief in the medication. Education from the prescriber on what the medications are specifically used can potentially assist the patient to be more comfortable with taking the medication. With thorough education and routine medication reviews, providers can assist in aiding patients in maintaining their medication regimen and retaining the maximum quality of life (Silavanich et al., 2019).

Giving the patients as much control over their medications improves their ability to maintain autonomy and self-worth. Family and friends are also important when dealing with the multiple issues facing elderly patients. Daily activities such as household chores and errands around town can become more problematic in the geriatric population. Family and close friends help when they are involved and present. This is important especially for those elderly patients living alone to maintain their autonomy and living at home instead of an assisted living. It is important to communicate and identify aspects of the elderly’s concept of quality of life (van Leeuwen et al., 2019). Memory dysfunction, personal beliefs about medication, and a lack of routine among other factors can create variation to medication regimen adherence making it difficult for patients to sustain their desired living arrangements. Concerned, involved individuals help retain routine and can be present to clarify the reason behind each of the medications prescribed. Collaborating with the friends and family of patients is a key point to cover when collaborating with our patients (Park et al., 2018).

Regarding polypharmacy in the geriatric population, the clinician along with other professionals in the interdisciplinary team have a key role in ensuring patient safety and providing adequate education to the patient, their families and to their care provider. The clinician’s role include reviewing the patient’s current medication list and/or herbal therapy as well as understand its clinical indication and the possibilities for drug-to-drug interactions. According to Dahal in 2022, identifying and assessing the safety of polypharmacy in geriatric population is the start of lessening the risks involved with polypharmacy. The clinician’s role also includes deprescribing medications that are no longer indicated and are more harmful than beneficial, decrease inappropriate drug use, assess efficacy of each drug, optimizing dose regimen, organize source of each medication, and provide adequate education (Dahal & Bista, 2022). Prior to prescribing a new medication, the clinician role includes assessing the medications risk and benefits, ensuring that there is a clear indication, to first consider a non-pharmacological option, affordability, life expectancy and compliance (Dahal & Bista, 2022). Clinicians should also ensure that the patient follow-up to assess the safety and effectiveness of the newly prescribed medication while utilizing The American Geriatrics Society (AGS) Beers Criteria (NIA, 2021). The American Geriatrics Society (AGS) Beers Criteria is updated every three years and is used to safely prescribe medications to the geriatric population and its intention is to ”improve medication selection, educate clinicians and patients, reduce adverse drug events, and serve as a tool for evaluating quality of care, cost, and patterns of drug use of older adults” (AGS, 2019). The clinician should also ensure to consult a pharmacist or another reliable resource when in doubt about prescribing or managing medications (Chippa & Roy, 2022).

Providing patient education is a crucial factor in helping to reduce polypharmacy. Patients, family, and care providers should be educated on the importance of keeping an up-to-date medication list that includes dose, frequency, indication, side effects, dietary and drug interaction as well as educated on medications that have a similar sound (Saljoughian, 2019). Patient education should also include teaching the importance of compliance, avoiding sharing of medications, avoid doubling up if a dose is a missed, to notify the provider prior to stopping, organize medications, and securing it in a safe place (Saljoughian, 2019). Patients should also be educated to never hesitate to contact their provider or the pharmacist for any questions and concerns. During the teaching, a lengthy face to face meeting is valuable and effective in building good rapport with the patients and their families. The clinician’s role and direct involvement in managing medications as well as providing extensive patient education can significantly decrease the implications from polypharmacy.