Polypharmacy in Elderly Patients

Polypharmacy in Elderly Patients

Problem identification and Background Evidence

Topic Choice – Rationale and Reflection on Practice

Nursing practice has witnessed an increase in the number of elderly patients seeking medical care due to conditions related to old age. In response to the increasing medical needs, the rise of polypharmacy in elderly patients has increased. In the United States, the increase in polypharmacy in the recent past is increasingly causing a burden to the public health sector and nursing practice. The contribution to drug-related morbidity is undoubted. Despite the increasing reports in polypharmacy, there is a lack of real-world information and data on the influence and reach of the practice. Past research has focused on the need for the administration of multiple drugs to treat one or more conditions in one patient (Bradley et al., 2014). The study of multi-drug combinations continues to show that almost 30 per cent of the US population is prescribed to multiple drugs. In light of the increasing number of reported cases on multi-drug morbidity, there is a need for research on the effect of these drugs on patients. There is a need to assess the impact of multi-drug use on the health of elderly patients as they are the most affected demographic.

There is an increasing elderly population in the world owing to the development of better healthcare systems across the globe. Most developed countries today have strict healthcare systems that are responsive to any healthcare trends. Today, 10 – 20 per cent of the world is reported to be prescribed to the use of five or more drugs at a go. 40 to 60 per cent of older adults are said to have been prescribed to the chronic use of five or more medications (Oktora et al., 2019). Vulnerable and frail older adults are especially affected due to their decreasing efficiency on drug responsiveness.

In Europe, the prevalence of polypharmacy in the general population five years leading to 2012 was 0.2 – 0.3 per annum (Guthrie et al., 2015). In the United States, higher numbers have been observed with the figure rising to 0.6 per cent. Most patients were recorded to need preventive medication such as proton-pump-inhibitors and cardiovascular drugs. However, the prevalence of affected number differs by country according to the available nursing practice standards.

To date, there is little known in polypharmacy and associated drugs. In the Netherlands, for instance, the population levels providing data for research only increased by 0.47 per cent in 2015. Considered, there is a challenge to nursing professionals as there is no statistical data to work with for a better solution (Octora et al., 2019). Other studies also show that children are increasingly getting prescribed with multiple drugs. This does not, however, dissuade the most affected demographic – the elderly. This research is thus informed by the need to quantify the scale of polypharmacy and multimorbidity drugs in the UK and other countries across the world. By obtaining insights informed by age data, there is an opportunity to assess the prevalence rates and create a need for a responsive long-term solution for the prescriptions.

Background evidence (Summary Literature Review)

The concomitant use of multi-prescription drugs in the UK has increased with 30 per cent of the population prescribed to more than five drugs Health and Social Care Information Centre (2017). The trends have also been observed in other countries such as Sweden, Brazil, China and India. The high rates of comorbidity in the UK and the US have been marred by incidents of insufficient supervision which has exacerbated clinical practice. In the US and the UK, the problem is increasingly burdensome to the public health sector with governments having to allocate billions of dollars to combat the trends. For instance, every 4 of 1000 hospital admissions have been attributed to polypharmacy (Salive et al., 2013). The financial burden on government has been enormous. The US estimates the annual cost to the US $30 to $180 billion per year. The increasing costs necessitate the call for action for nursing practice.

Polypharmacy is reported to have adverse effects on the ageing population. The literature on the practice shows that exposure to multiple drugs is a leading cause of drug delinquency. According to Anderson et al. (2014), the elderly at an increased risk of the wrong prescription created by the administration of multiple drugs. Anderson also states that due to the complicated nature of the disease and related conditions, doctors are increasingly prescribing the wrong drugs which continue to raise clinical complications. For the study, the study helps put the short and long term effects of multi-drug use in older patients. Drug-disease interactions among the elderly have increased in recent years. Aspinall et al. (2014) explore the prevalence of factors associated with drug-disease communications. The cross-sectional study infers that patients over the age of 65 are at risk since they are easily diagnosed with kidney failures, have a history of falls, heart failures and cognitive impairments. From the foregoing, literature to support the research points to the recent challenge in nursing practice where elderly adults (over 65 years) are most affected (Komiya et al., 2017). In other instance, they have been reported to experience falls which in turn exposes them to more medication.

Research shows that multiple drug use has singular effects with additive risks. In a study of the elderly groups, it is reported that increased disease-drug interaction may act to the detriment of the elderly patient. For instance, the prescription of a drug while continuing with others may serve to inhibit the performance of the prior drug. The drug may also enhance the risks associated or create new risks to the patient. According to Doan et al. (2013), it is estimated that 20 per cent of adverse drug complications are attributed to underlying drug interactions. The effect of multi-drug use on nursing practice has been scarcely documented. De Angelis et al. (2015) argues that nursing professionals may help in reporting the incidence of polypharmacy. However, the reports will usually depend on the intrinsic and extrinsic factors linked to professional nursing interactions. These factors include insecurity, ignorance, lethargy and fear. The healthcare organisation must thus have the capacity and skills to evaluate every case by its unique characteristics.

 

Proposed service innovation

In nursing practice, the prevalence of polypharmacy rates has been reported in most developed countries, including the UK, China and the United States. Multiple-drug prescriptions have been reported at over 50 per cent of adults over the age of 65. To reduce the dependency on multiple drug use, the nursing sector may use a few proposals to reduce the health effects caused by polypharmacy. First, Kirchberger et al. (2012) suggest an evaluative model where data from the elderly population is assessed. By conducting the assessment on the prevalence rates, the cost of treatment on government will need revision. Understanding the scope also provides an opportunity for the evaluation of alternative options and comorbidity to provide one-all solutions to drugs. As such, nursing practice research needs new models of operation where multi-purpose drugs are developed for the benefit of older adults over the age of 65.

Lastly, proper communication has been observed as a critical hindrance in the reporting of multi-drug use. Kirchberger et al. (2012) assert that through adequate communication models and publication of research on prevalent numbers, there is an opportunity for a united discourse on the way forward. Nurses have to interact with their patients to assess the effects of prescribed drugs and their need (Wright, Scott, Buck & Bhattacharya, 2019). An analysis of these drugs creates a symptomatic evaluation model that leads to a developed best practice model to promote research for future solutions to polypharmacy in older adults.

References

Oktora MP, Denig P, Bos JHJ, Schuiling-Veninga CCM, Hak E (2019) Trends in polypharmacy and dispensed drugs among adults in the Netherlands as compared to the United States. PLoS ONE 14(3): e0214240. https://doi.org/10.1371/journal.pone.0214240

Anderson, K., Stowasser, D., Freeman, C. and Scott, I. (2014). Prescriber barriers and enablers to minimising potentially inappropriate medications in adults: a systematic review and thematic synthesis. BMJ Open, [online] 4(12), p.e006544. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4265124/ [Accessed 15 September 2019].

Aspinall, S.L., Zhao, X., Semla, T.P., Cunningham, F.E., Paquin, A.M., Pugh, M.J., Schmader, K.E., Stone, R.A. and Hanlon, J.T. (2014). Epidemiology of drug-disease interactions in older veteran nursing home residents. Journal of the American Geriatrics Society, 63(1), pp.77–84.

Bradley, M.C., Motterlini, N., Padmanabhan, S., Cahir, C., Williams, T., Fahey, T. and Hughes, C.M. (2014). Potentially inappropriate prescribing among older people in the United Kingdom. BMC Geriatrics, 14(1).

De Angelis, A., Colaceci, S., Giusti, A., Vellone, E. and Alvaro, R. (2015). Factors that condition the spontaneous reporting of adverse drug reactions among nurses: an integrative review. Journal of Nursing Management, 24(2), pp.151–163.

Guthrie, B., Makubate, B., Hernandez-Santiago, V. and Dreischulte, T. (2015). The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995–2010. BMC Medicine, 13(1).

Health and Social Care Information Centre (2017). Health survey for England 2016 prescribed medicines. Available at: http://healthsurvey.hscic.gov.uk/media/63790/HSE2016-pres-med.pdf (Accessed: 15 September 2019).

Kirchberger, I., Meisinger, C., Heier, M., Zimmermann, A.-K., Thorand, B., Autenrieth, C.S., Peters, A., Ladwig, K.-H. and Döring, A. (2012). Patterns of Multimorbidity in the Aged Population. Results from the KORA-Age Study. PLoS ONE, 7(1), p.e30556.

Komiya, H., Umegaki, H., Asai, A., Kanda, S., Maeda, K., Shimojima, T., Nomura, H. and Kuzuya, M. (2017). Factors associated with polypharmacy in elderly home-care patients. Geriatrics & Gerontology International, 18(1), pp.33–41.

Salive, M.E. (2013). Multimorbidity in older adults. Epidemiologic Reviews, 35(1), pp.75–83.

Wright, D.J., Scott, S., Buck, J. and Bhattacharya, D. (2019). Role of nurses in supporting proactive deprescribing. Nursing Standard, 34(3), pp.44–50.