appealing for symptom relief but can present consumers with potential side effects and interactions that can create a cycle of drug use that may be problematic. Ironically, using increased numbers of pharmaceuticals may alleviate some symptoms while potentially creating new side effects, complications, and even the perception and presentation of a new ailment. Five or more medications The issue of polypharmacy can affect all adults who take five or more medications. The most notable suggested increased rate of polypharmacy is 12.8% to 39%. This extremely high rate of increased medication utilization was presented in adults over age 65 between the years of 1988 to 2010 (Wang et al., 2023). This clearly shows an alarming health challenge and concern that needs to be addressed and understood as these cohorts increase in size while experiencing longevity. In a sense of irony, the medications that extend longevity and improve the lives of those living with chronic conditions can be triggering symptoms that have negative implications for aging and quality of life. The outcomes of polypharmacy, driven by multimorbidity, can be dire, with financial consequences that impact quality of life as well as the functionality of the healthcare system. The challenging consequences of addressing multiple physical and mental health conditions that include side effects and symptoms, medication management, potential drug interactions, increased rates of adverse drug events, and nonadherence to treatment plans. More specifically, outcomes of the aforementioned consequences include increased fall risk, renal failure, frailty and fractures, all of which can increase rates of morbidity, mortality, and unexpected hospitalizations. Excessive hospitalizations can increase rates of readmission which is a direct correlate to high levels of polypharmacy (Wang et al 2023). In this twisted reality there is also the realization that these situations are correlated to increased rates of absenteeism in the workplace, higher healthcare costs, higher levels Hyperpolypharmacy (Excessive polypharmacy) Box 1: Disease with Most Frequent Hyperpolypharmacy ● Diabetes mellitus
Self-Assessment Quiz Question #2 Which statement is true? 1. There are never treatment plans in which polypharmacy is necessary. 2. There are some treatment plans in which polypharmacy is necessary.
of disability, and other trickle-down effects that impact functionality and independence. Older adults who are living with frailty have a 59% rate of polypharmacy (Wang et al., 2023) and a 22% rate of hyperpolypharmacy, which is a term applied to the person who takes 10 or more medications concurrently. Frail older adults may experience accelerated rates of decline that can further exacerbate their loss of physical and mental strength and decline in overall health, directly correlated to increased risk of mortality. As stated prior, those managing cardiovascular conditions have higher rates of polypharmacy, which can be a direct cause of further disease and increased use of various medications. Elderly patients with other conditions such as chronic kidney disease may find the trajectory of their respective illnesses impacted with the effects of additional medication and treatment. Self-Assessment Quiz Question #3 What is true about medications? 1. Medications are the innovation that has prompted longevity, and the benefits always outweigh the risks. 2. Medications would not be released to the marketplace if they were not tested on all populations for safety. 3. Medications can address symptoms and prevent disease progression, but they can also trigger adverse reactions and events. 4. Medications should not be taken unless there is no other option for symptom relief. ● Personal preference to not take the specific medication ● Lack of effectiveness ● Concern for safety ● Desire to reduce the number of medications ● Desire to be engaged in decision making Providers must follow guidelines pertaining to medication deprescription (Rana et al., 2022): ● Identify medications that have a greater risk versus beneficial impact ● Analyze dose and frequency ● Engage the patients that are receptive to deprescribing ● Gain insight into all medications taken, including prescription, OTC, and supplemental to identify risks versus benefit Healthcare Consideration: Patient preference must be considered prior to deprescribing medication for hyperpolypharmacy situations. Accuracy of current medications is imperative to safely analyze next steps, potential deprescribing, and continued disease management with risk mitigation. For older adults with hyperpolypharmacy who express an interest in stopping or specifically deprescribing medication, their primary reasons expressed are due to a desire to take fewer medications, and they feel a lack of indication that the medication is working due to lack of symptoms (Rana et al., 2022).
● Chronic kidney disease ● Cardiac failure—80% on 7+ medications ● Chronic mentally ill
● Hypertension ● Coronary heart
disease—60% on 7+ medications
(Matthia et al., 2021) In some situations, the benefits of polypharmacy may outweigh the risks, and at times the risks may outweigh the benefits (Toh et al., 2023). (See Box 1.) For some older adults, the adverse outcomes of polypharmacy may minimize disease risk, prolong life, and enable them to maintain a meaningful quality of life. It is important to monitor the effects of each medication introduced into an older person’s sustaining regimen with the recognition that there are an increasing number of people who are entering hyperpolypharmacy, which is taking over ten medications daily. According to Rana et al. (2022), 75% of older adults living with hyperpolypharmacy have expressed a desire to lower the number of medications they are taking with the deprescribing of at least one medication. Reasons for stopping medication include: ● A perceived lack of purpose or indication
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Book Code: MTX1326
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