Chapter 4: Polypharmacy: Impact and Effects 3 CE Hours
Course overview This intermediate-level course will explore the realities for people taking multiple medications, mostly older adults. Medication management is a challenge that can have impact on physical and mental health. Inadvertent misuse of medication can not only affect the individual, but also the caregiver, and the greater community. It is important that all healthcare providers gain insight into this challenge Learning objectives After completing this course, the learner will be able to: Differentiate multimorbidity, polypharmacy, and hyperpolypharmacy and their effects on disease management. Analyze the impact of multimorbidity and symptom and medication management. Examine effects of polypharmacy on specific age-related diseases.
to understand the effects of polypharmacy, the impact on disease management, and effects it can have on treatment plans and long-term recovery. Content includes aspects of multimorbidity, disease-specific polypharmacy issues, insight into hyperpolypharmacy, effects of polypharmacy on aging and quality of life, and deprescribing. Relate the impact that polypharmacy and hyperpolypharmacy have on increasing fall risk for older adults and vulnerable populations. Examine the steps for deprescribing under the management of appropriate clinician oversight. Identify disease-specific pharmaceutical therapy that is frequently prescribed for condition management. Determine the impact of polypharmacy preceding a prescription cascade that can create additional symptoms and interfere with outcomes
INTRODUCTION
even greater number of medications. In many situations the medications go to waste, they expire, or prescriptions change. There are labor costs associated to this situation as well as healthcare professionals who spend more time reviewing complex medication regimens that add responsibilities to their workloads. Additionally, the risk of adverse events is most distressing for the patient and the healthcare system. Polypharmacy increases the risk of an emergency room visit, hospitalization, readmission, and increased morbidity and mortality. Patients with manageable age-related chronic conditions can develop into complex cases that can include severely impaired quality of life. Empowering patients to engage in self-care necessary to manage their chronic conditions is a collaborative effort between patients, providers, and the respective care team. Since over 50% of adults living with any chronic condition may have more than one disease (Skou et al., 2021), there is an imperative to educate, inform, and engage them and expand their health literacy, especially as it pertains to their personal aging journey. It cannot be understated that the treatment process managing age- related conditions can present the unexpected, sometimes life-threatening outcomes, that can change the trajectory of a life with negative implications for the individual, as well as the greater healthcare system. Gaining insight into multimorbidity and subsequent polypharmacy will help clinicians better support their patients. Developing a strategy to reduce polypharmacy while continuing to provide therapeutic treatment will ultimately trickle downstream through the healthcare systems, greater community, families, caregivers, and individual lives who can shift from a lifespan with longevity to a healthspan with fewer conditions and a better quality of life.
The Journal of the American Medical Association , as stated by Vordenberg et al. (2023), asserts that polypharmacy is the “excessive or unnecessary use of medications,” most commonly in older adults. The challenge of overprescribing has been growing since the early 2000s, as the number of adults living with multiple chronic conditions has increased. Addressing this issue is of vital importance as older adults age while simultaneously experiencing increased lifespan and impaired healthspan, or number of healthy years with positive quality of life. Every day approximately 11,000 people are turning 65 in the United States as the cohort of older adults grows throughout the world. According to Bautmans et al. (2022 between the years of 2000 and 2050, the population of people over age 60 will double, with those age 80 and above quadrupling in size. This growth is a result of innovative advances in healthcare and increased socioeconomic opportunity but is aligned with the reality that with longevity comes the risk of age-related health conditions. These conditions impact vision and hearing and include increased rates of frailty, diabetes, cardiovascular disease, Alzheimer’s disease, and depression. Managing these conditions is reliant on healthy lifestyle, diet, exercise, and social connection, as well as clinical treatment support which is directly designed to promote healthy longevity and symptom relief. There are other aspects of polypharmacy that go beyond the individual patient. Polypharmacy is correlated to increased healthcare costs based on such expenses as frequent doctor visits and managing and monitoring multiple medications and their refills. Patients who experience hyperpolypharmacy (10+ medications daily) must purchase and maintain refills and supplies for an
Healthcare Consideration: There are times in which the use of multiple medications is clinically appropriate and part of a therapeutic treatment plan, but it is important to recognize the patients that are more vulnerable to risks, including increased rates of morbidity and mortality. It is time for a shift toward “appropriate polypharmacy” which will require a shift in approach within the healthcare environment, increased levels of patient education and engagement, and acceptance for the reality that patients with multimorbidity require deeper oversight relative to pharmacological treatment (Masnoon et al., 2017).
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Book Code: MTX1326
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