Polypharmacy: A Growing Concern in Long-Term Care

• Polypharmacy refers to the practice of taking several medications concurrently to treat these conditions. 
• Polypharmacy has the potential to become problematic, especially in cases where elderly patients are prescribed too many medications by multiple healthcare providers working independently of each other. 
• Since nurses are the main point of contact for the patient receiving long-term care, they play a key role in communicating their observations of a patient’s response to treatment to the prescribing physician. 

What Is Polypharmacy?

In many long-term care facilities today, elderly patients are prescribed a wide variety of medications to manage chronic health conditions and pain.  

Polypharmacy refers to the practice of taking several medications concurrently to treat these conditions. Polypharmacy has the potential to become problematic, especially in cases where elderly patients are prescribed too many medications by multiple healthcare providers working independently of each other.

Adverse drug interactions can also happen if the healthcare provider does not understand the patient’s complete medical history.  

Nurses have a key role in identifying those elderly patients most at risk for polypharmacy and to educate the patients and family about risk reduction.  

What Are the Issues of Concern?

Due to the many side effects of medications, polypharmacy can increase the risk of vision and mental impairment in the elderly. It can also increase the risk of falls and injuries such as hip fractures.  

The other complications that can arise from polypharmacy are frailty, disability, multiple visits to the clinic, and prolonged hospital stays.  

What Kind of Medications Are Considered High Risk for the Elderly Populations?

Cardiovascular Medications

A few commonly prescribed cardiovascular medications such as Clonidine and Methyldopa can cause low blood pressure and sedation.  

Narcotics

A few examples of narcotics that are commonly prescribed to the elderly to control pain are Hydrocodone, Oxycodone, and Tramadol.  

All these medications share a common side effect confusion and sedation. In addition to those side effects, narcotics commonly slow breathing and at times cause respiratory failure.  

Anticholinergic Medications

Medications such as antidepressants, muscle relaxants, and antihistamines are also commonly prescribed for the elderly and can cause memory loss, hallucinations, and blurry vision. 

Non-Steriodal Anti-Inflammatories

These medications can increase the risk of kidney failure, gastrointestinal bleeding, and high blood pressure.  

Due to all the potential adverse events and increased risk of injury to the elderly patient taking these medications, use should be minimized if possible. 

How Can Nurses and Other Health Professionals Reduce Medication Risks in Older Adults?

• Keep an accurate and up to date list of all medications, including generic and brand names, dosages, frequency, and reason for taking the drug. 
• Keep a complete list of medical providers and their contact information. 
• Have the name and phone number of the local pharmacy. 
• Educate the patient and family about each medication, its purpose, and effects. 
• Deprescribe medications. 

What is Deprescribing and When Is This Approach Appropriate?

Deprescribing is the approach used to identify and discontinue medications in which the potential harm outweighs the benefit of taking the drug. It also includes discontinuing medications with no clear benefit at all.

The goal of deprescribing is to reduce adverse effects of polypharmacy. The medications with the highest risk of injury or other harm should be discontinued first.  

Nurses cannot discontinue medications without physician approval. It is important the nurse keep the lines of communication open and report any concerns about prescribed patient medications to the physician as soon as possible. 

What Are Specific Tools That Can Be Used to Evaluate Polypharmacy in the Elderly?

The Hyperpharmacotherapy Assessment Tool (HAT)

This tool is comprised of six goals: 

1. Monitor number of medications used 
2. Decrease inappropriate drug use 
3. Decrease inappropriate pharmaco-therapy 
4. Optimize dosing 
5. Organizing sources of medicine 
6. Patient education 

Screening Tool of Older Person’s Potentially Inappropriate Prescriptions

Also known as STOPP, this tool is used to identify drug interactions, duplicate therapies, and inappropriate prescription use in the elderly. 

Anticholinergic Drug Scale

This is useful for elderly patients in nursing homes, hospitals, and community settings.  

This list provides 117 medications that commonly affect cognition, functional activity, falls, hospital readmission, and mortality. 

The Bottom Line

In conclusion, polypharmacy is a growing concern when treating the elderly population.  

Since nurses are the main point of contact for the patient receiving long-term care, they play a key role in communicating their observations of a patient’s response to treatment to the prescribing physician. Although it is important to reduce the use of unnecessary medications, it is also important to take each patient’s medical history and situation into account.  

Drug Discontinuation to improve quality of life should not be at the expense of making stable chronic conditions unstable. Keeping these things in mind when evaluating medications and deprescribing will ensure the best health outcomes for the patient.  

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