Polypharmacy and the older adult Physiological changes impact functionality, health, wellbeing and quality of life. Age-related bodily and metabolic changes can affect the way in which medications and other pharmacological treatments work. Compounding that challenge is the recognition that providers and researchers are acquiring much-needed insight and knowledge to address newer challenges that old age can present, learning as they apply treatment protocols. Progress in treatment can be made with new medications, including prescription, over the counter, and supplemental vitamins. The interactions and counter effects are relatively unknown on the older cohort of people over age 85, contributing to the perpetual balancing act required to identify and manage the right combination of medications to address symptoms and increase longevity while maintaining quality of life. Manguson et al. (2019) report that further expert research is needed to address prescribing challenges specific to older adults: ● Pharmacokinetics : the study of the absorption, distribution, metabolism, and excretion of medications, which are directly impacted by: ○ Physical aspects of disease, disease management, and utilization of medications and other treatments that can affect disease outcomes ● Pharmacodynamics : the study of the impact of medication on the body, including bodily responses based on drug concentration, drug, and receptor interactions ○ Outcomes are impacted by declining changes in cell functionality and age-related sensitivity to pharmaceuticals and treatment There are other aspects of the aging process that correlate to the expansive complexity of medication management and effective treatment of older adults (Manguson et al., 2019): Polypharmacy and clinical consequences Patients taking multiple medications do so for reasons that can include (Wang et al., 2023):
Age-related effects on organs: ● High pill burdens for disease and symptom management ● Complicated medication regimens ● Large number of healthcare professionals and other people influencing treatment, disease prevention, and management: ○ Primary care providers ○ Specialists ○ Allied health professionals ● Duplication of medication and unnecessary medication ● Undertreatment and medication avoidance or omission ● Fragmented care coordination Evidence-based practice! Low health literacy can be a challenge and barrier when presenting options with medications. Patient insight must be considered, even with limited health literacy. Lee et al, (2022) recommend considering beliefs about medications, prior experiences, influence of members of care team including family, and willingness to follow through on treatment plan. The Patient’s Attitudes Towards Deprescribing (PATD) Questionnaire was created and validated to unveil older adult attitudes, beliefs, and concerns about medication and potential deprescribing. This tool examines the patient’s perspective and feelings about the medications they are taking. Lee reports that over 60% of older adults who completed this survey reported that they felt they were taking too many medications, and 92% stated that they would stop one or more of their protocols if possible. The revised version of the tool, rPATD, evaluates family and caregiver perspective relative to the patient. ○ Pharmacists ○ Caregivers ○ Family and loved ones ● Polypharmacy can become ordinary treatment for people living with multimorbidity, many of whom experience higher rates of unexpected hospitalizations that can result in additional medications prescribed with limited information (if there are multiple electronic health records systems being utilized) ○ Often these patients receive interacting treatments that can cause further disruption. ○ Treating patients with multimorbidity and polypharmacy can also drive up costs due to duplication of treatment. ● Drug-drug interactions (DDIs) can be a challenge Substantial increases in medication use can occur when there is limited information exchanged directly with patients. Patients may not be informed about the significance of maintaining and appropriate, consistent dosage scheduling for effective medication management, they may not understand the risks of unintended mismanagement. Polypharmacy, as a means of addressing multiple chronic conditions, may be initiated with the desire to improve quality of life and positively impact life expectancy, but can be catastrophic. The reality of polypharmacy is that the use of multiple medications may put patients at increased risk for varied adverse health outcomes. These outcomes can include drug interactions, hospitalizations, increased costs, presentation of new symptoms, side effects, and reduced feelings of wellness. in disease treatment; 2% to 77% of older adults undergoing cancer treatment experience DDIs.
● Treat symptoms ● Prevent disease
● Address complications ● Increase life expectancy ● Preempt disease risks ● Treat side effects ● Reduce pain ● Minimize disease exposure ● Address genetic predisposition ● Self-medication ● Reduce impact of disease or condition ● Want to improve ● Want to feel better ● Finding a cure ● Benefits outweigh the cons ● Addictive disorder
As people respond to their health-related conditions with various medication the research is showing that while there are circumstances in which multiple medications are needed, polypharmacy has clinical consequences can be negative and alarming (Wang et al., 2023): ● Polypharmacy can occur due to nonadherence to treatment plans, unintended drug interactions, and adverse drug events, which can result in the patient taking more medication to address additional symptoms. ● Adverse events caused by drug interactions are correlated to increased risks of bodily harm, disability, dementia and cognitive decline, and death.
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