and appropriate treatment offered for their health-related conditions to avoid the effects of polypharmacy, perhaps
even hyperpolypharmacy, and an ultimate prescription cascade.
Case study 1: Mrs. Evelyn Turner—A multifaceted patient Mrs. Evelyn Turner, an 88-year-old widow residing in the Maplewood Nursing Facility , presents a rich tapestry of medical challenges that are deeply impacted by her age, frailty, and vulnerability. Her children and grandchildren visit her regularly. Patient Profile ● Name : Mrs. Evelyn Turner ● Age : 88 years Patient background and insight: ● Widowed : She recently lost her husband of 62 years and often refers to him ● Fall and Broken Hip : Three years ago, a fall resulted in a fractured hip, altering her mobility and ability to maintain independence ● Breast Cancer Survivor : Diagnosed at 64, she underwent surgery and chemotherapy ● Osteoporosis : She is somewhat stooped due to her bone loss and lack of regular mobility
○ Breast cancer follow-up and monitoring : ▪ Regular mammograms and clinical breast exams ▪ Exam for recurrence or new primary tumors ▪ Provide support for self-examination of breasts, if appropriate 4. Pain management : ○ Chronic Pain : Recognize impact of pain and evaluate approaches; ensure patient receives supportive pain therapies, including physical therapy and mobility support; provide cognitive behavioral therapy to support mental health aspect of chronic pain ○ Nonpharmacological approaches : ▪ Physical therapy for joint mobility ▪ Heat/cold therapy for localized pain ▪ Gentle exercises to maintain muscle strength 5. Frailty management : ○ Nutrition and hydration : Ensure adequate protein intake to prevent muscle wasting; avoid dehydration ○ Exercise : Engage in appropriate, tailored exercise plan that can include chair exercise, light walking, and chair yoga ○ Fall prevention : Collaborate with occupational therapists for adaptive aids (e.g., grab bars, raised toilet seats), address gait and balance through physical therapy 6. Social support : ○ Family involvement : Engage family members and support in care discussions ○ Community resources : Explore local senior centers, support groups, or volunteer programs to combat loneliness Reflection : With a well-thought-out treatment plan that includes a managed medication regiment and physical therapy, light exercise, and social engagement, Evelyn can address her pain management and depression. Additionally, with proper diet and hydration, she will gain strength to continue her therapies as her quality of life improves. equitable manner, following best practices, for improved outcomes. Hospital care delivery is referred to as patient- centered, the term used to refer to high-quality and high- value healthcare that includes shared decision-making and service delivery that supports the person’s preferences, needs, culture, and connection (Edgman-Levitan and Schoenbaum 2021). Hospitals have mission statements that serve as a guide and provide focus about their “why” for existence. Their mission and values clearly state the expectations they have relative to serving their community. See Table 6. The mission and core values of the top hospitals in the United States are powerful reminders of the impressive work being done to support communities, community members, and public health, while serving individuals lives for best outcomes. Recognizing that polypharmacy can be a direct correlate to “any hospitalization, unplanned hospitalization, and rehospitalization” as quoted by Qin et al (2023) is part of identification of the steps needed to take to address the largesse of the problem. Throughout the world, research shows that polypharmacy is a contributing factor to hospital admissions (see Table 7).
● Frailty : A state of vulnerability that necessitates tailored interventions and has impaired her mental health; she is clinically depressed Clinical challenges 1. Age-related issues : ○ Polypharmacy : Evelyn’s expansive medication regimen must run like clockwork throughout the day. Balancing pain management, osteoporosis treatment, and cancer surveillance requires judicious prescribing, monitoring, and reconciliation ○ Depression : The emotional toll of chronic pain, cancer history, and loneliness contributes to her depressive symptoms, providing mental health support services is crucial 2. Fall risk assessment: ○ Evaluate gait, balance, and muscle strength ○ Assess environmental hazards within the nursing facility ○ Collaborate with physical therapists for fall prevention strategies 3. Oncology follow-up : Polypharmacy and hospitalization The potential effects of polypharmacy are expansive, unwieldy, unexpected, costly, and can differ between individuals based on other variables. Over one-third of all prescriptions written in the United States are for residents of nursing homes, most of whom are older adults who are vulnerable and living with multimorbidity. Research (Pazan and Wehling, 2021) shows that approximately a quarter of that population experiences a minimum of one hospitalization annually. Furthermore, it is known that outcomes of polypharmacy, driven by multimorbidity, can have extreme outcomes that require hospitalization for anyone living with multiple illnesses, often surviving due to the sustaining factors of medication. To make matters even more challenging and complex for patients who are hospitalized (potentially due to the attributes of polypharmacy) patients may receive additional medications, some of them duplicated as noted, in an effort to address symptoms while inadvertently creating more challenges that can impact their well-being, quality of life, and mortality. Public health is reliant on a high-quality hospital that is led by educated, driven healthcare professionals and providers who are committed to providing the best care, in an
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