If a patient is not able to actively engage in lifestyle modifications, Matthias suggests that heart disease and congestive heart failure are diseases in which polypharmacy may be the best method of treatment. Having stated that, providers should always recommend that patients integrate healthy lifestyle choices into daily living. Addressing symptoms of heart disease with medication may delay diagnosis, result in polypharmacy, and ultimately prescription cascade, which can not only delay treatment but have catastrophic consequences. Polypharmacy and falls Falls are a public health issue, and typically older women are at a higher risk when compared to men (Psomas et al., 2022). While some falls have nominal outcomes, for older people they can lead to impaired mobility, loss of independence, increased morbidity and mortality. Falls can be due to many issues including poor lighting, home tripping hazards, lack of focus, and polypharmacy. A fall can be described as the following, according to Psomas: ● Unexpected event, including a slip or trip ● Loss of balance ● Landing on the ground or floor ● Tripping and hitting an object (chair, table, desk) ● A physical event stemming from a push or force Women with polypharmacy that include 5 to 9 different medications, have a significantly higher chance of experiencing a single fall, multiple falls, and potentially injurious falls (Psomas et al., 2022). According to Kruschke et al. (2017), the Centers for Medicare & Medicaid Services reports the following relative to falls: Polypharmacy and sarcopenia Sarcopenia is age related muscle loss and is often associated with a decline in physical function and mobility due to muscle weakness (Prokopokis et al 2023). There is limited research on the correlation between polypharmacy and sarcopenia, however, there is the recognition that limiting the affects and damage from sarcopenia is important to healthy aging, strength maintenance, and quality of life. Medications that cause side effects such as lethargy and sleepiness can increase rates of sarcopenia while also limiting the ability or interest in movement and strength training, two behaviors that can impact rates of muscle loss due to aging. There are some drugs that impair muscular response to exercise (Prokopokis et al., 2023): ● Antidiabetic drugs can inhibit hypertrophic responses following exercise ● Beta-blockers can impair muscular adaptation to exercise and interfere with exercise activity ● Glucocorticoids and anti-proliferative drugs that are used for cancer treatment can impede mitochondrial function ● Drugs that inhibit appetite can cause changes to gut microbiota Safety deprescribing the foregoing medications, when appropriate, may improve nutritional status while improving outcomes of movement and exercise and slow down sarcopenia. Another aspect of polypharmacy relative to sarcopenia is that there is potential for multiple medications to collectively contribute to muscle wasting and weakness
Evidence-based practice! Heart disease and cancer are the leading causes of death throughout the world, sharing many risk factors that include lifestyle, gender, age, and other chronic illnesses including diabetes and obesity. Many cancer treatments notably increase the risk of heart disease, with many dying from cardiovascular events. The “co-existence” (as quoted by Wyler Von Ballmoos and Almassi (2022), of the disease processes, respectively, there is a dire need for deeper understanding of disease management and therapeutic treatment to address the prevalence of these conditions. ● Each time a person falls, they increase their rate of future falls by 50%. ● 20% of falls experienced by older people can lead to serious injury or death. ● The cost of nonfatal falls exceeded $50 billion in 2023 (CDC). ● Falls that happen in acute care settings are reimbursed with restricted payments. ● A consistent reason for older adult falls in all environments is due to effects of polypharmacy. Evidence-based practice! Centers for Medicare & Medicaid Services Medications can be linked to injuries as we age (cdc.gov) The CDC reports that three out of four older adults take at least one medication that can impair ability to drive and maintain balance. They have created a public relations campaign (see link) to inform and educate about the effects of medication and functionality. in older adults (Prokopokis et al., 2023). As there are higher rates of hospitalizations, falls, and frailty as the older population grows, there is an increased recognition by researchers that the relationship between polypharmacy and sarcopenia must be better understood to clinically manage co-occurring illnesses without putting the person at greater risk for muscle loss and weakness. Older adults with sarcopenia have a prevalence of malnutrition as well as other chronic conditions. These conditions include higher rates of: ● Depression ● Dementia ● Diabetes mellitus ● Osteoporosis ● Respiratory disease ● Hypertension ● Chronic kidney disease Independently, polypharmacy, depression, and sarcopenia are common conditions in geriatric patients, having been identified as age-related conditions with a variety of adverse symptoms and long-term effects. The direct impact they can have on physical functioning and ability cannot be denied. The effects of medication on sarcopenia can include changes in body composition, muscle loss, disability, increased surgical complications, and impaired recovery from other conditions (Table 9).
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