○ Digestive issues ○ Reflux ○ Arthritis ○ Constipation
negative implications for another condition. To make the situation more complicated, there is another reality that the potential for drug interactions dramatically increases as more medication is introduced into the mix. Furthermore, drug interactions may occur in unknown ways, especially with aging bodies that are experiencing metabolic changes with time (Pallesen et al., 2022). Additionally, patients may rely on their own insight relative to addressing new symptoms and side effects as they arise. The implications of polypharmacy may present or occur with five or more medications, which includes those that can be prescribed or over the counter (Cheng, 2021). There is growing concern for the use of appropriate medications for the correct reasons in the United States, as the prescription drug market grows and affects more people year over year. According to Cheng (2021), over a 10-year period ending in 2018, the number of Americans living with polypharmacy by using five or more drugs daily increased from 4% to 11%, with people 65 and above expanding from 13.8% to 41.9%. As the prescribing rates increase, there are potential risk factors aligned with the following (Cheng, 2021): ● Compliance issues ● Adverse drug reactions Polypharmacy and vulnerable adults Older adults who live full time in skilled nursing facility or nursing home are there because they require supportive help to meet their clinical needs and perform activities of daily living. The impact of the limitations of their capacity exacerbates vulnerability that extends beyond limited functional mobility: ● They are unable to manage chronic conditions ● Have regular limitations managing medication ● Struggle to follow up with their clinician and treatment plans ● Cannot implement a treatment plan without support There are over 15,500 skilled nursing facilities throughout the United States, with 1.4 million residents (U.S. News and World Report, 2024). According to Roh et al (2022): ● 40% of residents regularly take more than five medications per day ● 19.4% of residents regularly take more than seven medications per day ● The average number of daily medications by a nursing home resident ranges from 3.8 to 16.6. This high level of polypharmacy can lead to an increased likelihood of “potentially inappropriate medication” (PIM), which is correlated to increased risk for the patient. Chae et al. (2023) reported that nursing home residents who are engaged in polypharmacy have a two times increased risk of PIM. Thirty percent of those residents have a likelihood of experiencing an adverse drug reaction from the PIM. More than 25% of full-time residents in nursing homes have a minimum of one hospitalization annually, and many of these admissions are due to PIM, a situation that could “potentially have been avoided” according to Chae. While there is research and information supporting the correlation between potentially inappropriate medication, inappropriate prescribing, polypharmacy, and preventable ● Expanded risk of drug-drug interactions ● Increased purchases of over-the-counter medications for: ○ Allergies ○ Upper respiratory infections
It should be noted that people over age 65 purchase 40% of all over-the-counter medications (Cheng, 2021). According to the Food and Drug Administration there are over 300,000 over-the-counter medications (OTC), with more regularly entering the marketplace. Older adults may fill their medicine cabinets with many well-marketed products that contain ingredients with limited to no testing with the older adult population. Evidence-based practice! Safari et al. (2022) report that according to the Consumer Healthcare Product Association, there are adverse risk factors to taking OTC medications, in particular for older adults. Certain ingredients found in OTC products can be damaging for older adults. Diphenhydramine, marketed for allergies, colds, coughs, and sleep aids, can cause dizziness, confusion, increase fall risk, and impair cognition. Ibuprofen can cause internal bleeding ulcers, may increase blood pressure, and can interfere with antihypertensive medications. Ibuprofen can also lead to kidney damage in patients with congestive heart failure. This research makes it clear that to-date, there is limited research performed testing the efficacy of many drugs and studies on the risks with other drug interactions, on older adults. hospitalizations specific to nursing home residents, there is a lack of information relative to the actual risks within these facilities. There are tools that are available for skilled nursing facilities to use to assist with medication reviews (Table 4). The Beers Criteria have identified over three dozen specific medications that most older adults should avoid, plus an additional 40+ medications or medication classes they should avoid if they have certain chronic conditions (American Geriatrics Society, 2023). Older adults in nursing homes for long-term custodial care are receiving 33% of all prescription drugs in the United States, and the number is expected to increase as the population ages over time. This cohort of older adults needs more oversight and care due to their inability to perform activities of daily living and their reliance on daily care. The framework within which a nursing home facility functions relies on proper medication management for a population that has greater needs that can result in appropriate polypharmacy or can be the basis for overmedication that can exacerbate their state and contribute to greater frailty and the development of more conditions. Common issues among older adults living in skilled nursing homes and nursing facilities include (Rho et al., 2022): ● 41.4% of residents over age 70 with a dementia diagnosis were prescribed a psychotropic medication. ○ Antipsychotic medications are “commonly prescribed” for behavioral issues and disturbances. ○ Approximately 25% of nursing homes regularly prescribe antipsychotic medications for agitation on a regular basis, despite having 86% to 95% counter indications and warnings pertaining to older adults. ○ Antipsychotic medications and psychotropic medications can have profound impact on older adults that can cause:
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Book Code: MTX1326
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