Polypharmacy refers to the simultaneous utilization of different medications by an individual with the hope of treating more than one chronic condition. Although use of drugs has been employed to manage numerous health complications among the older adults, use of multiple drugs contributes to worsening health status, increased risk of adverse drug reactions and longer hospitalization. The study reviews the background of Polypharmacy, its significance, advantages and disadvantages, effects to nursing care, reactions of nurses to polypharmacy, its impact, and nursing implications.
Overview of Polypharmacy
Polypharmacy is a common characteristic among the hospitalized older adults and an identifier of the severity of diseases and clinical complexity (Sganga, 2014). Presently, there is a fast growth of the older populations, above 65 years. This is an effect of the increased life expectancy and improved health care services. Rising issues related to polypharmacy include heightened drug interaction, unfavorable drug reaction, and prescribing spillage. In pharmacology, it is unlikely to envisage the clinical effects of combined drugs use in the absence of precise combination of the drugs. The advantages of precise drugs over their disadvantages are dependent on the specific combination and diagnosis in every case. Nevertheless, the use of multiple drugs does not indicate poor treatment. Older persons who use multiple drugs have increased risks of hospitalization. This is according to the studies conducted by the Sganga (2015). In this study, it is necessary to evaluate the effects of programs to minimize polypharmacy on health outcomes. According to Patton, Hughes, & Cadogan (2017), polypharmacy can be a result of failure of the caregiver to discontinue the medications at prescribed, multiple providers prescribing the medicine, lack of regular review of the medication profile by the provider, using numerous pharmacies, and complying poorly with the medication regimes.
Significance of Polypharmacy
Polypharmacy is a common incidence in older adults who receive treatment for acute health complications (Sganga, 2015). A higher 30-day mortality and shorter general survival are experienced among the patients who take more than 4 different doses. Inappropriate use of the medication according to Beers criteria is unrelated with the clinical results (Wang, Camargo & Veluswamy, 2013). There are certain medications where the interaction of the drug with others positively when prescribed together achieves greater effects than the single gents used singly. This is especially common in anesthesia field and management of pain (Wolters, 2015). Some of the chronic illness among the older adults include high cholesterol, and heart diseases, and stroke. Application of multiple drugs is correlated to the application of the possible inappropriate medications. Multiple medications are inappropriate for older adults, majorly because of the outweighed risks than benefits.
Pros and Cons of Polypharmacy
There are diverse reasons for using more than one prescription of the drug. Among the benefits, include the high prevalence of the chronic diseases. This is especially evident in the older patients without acute problems. The high number of drugs is useful in managing treatable conditions (Garfinkel & Mangin, 2010). Polypharmacy has been credited as a fast and efficient approach of managing medical problems among the older adults (Wolters Kluwer Health Kluwer Health Kluwer Health, 2015).
However, polypharmacy causes drug interaction. Rather than applied as a prevention, it is mainly used as a cure. Most of the older patients prefer many symptomatic prescribing are end up inappropriately using the wrong dosage on the prescriptions. Sganga et al (2014) conducted a cohort study to find out whether polypharmacy among older adults increased the risk of hospitalization and mortality after the patients became discharged. The study discovered that adults under polypharmacy are at risk of becoming hospitalized again. However, there was relation between increased polypharmacy and mortality. Related application of the multiple drugs raises numerous relevant issues among the patients. There might be modification on the drug metabolism due to advanced age. Use of multiple drugs increases the risk of medication errors and likelihood of receiving insufficient mediation. There is also the risk of increased use of the number of drugs use to various interaction of drug –drug and drug-interactions (Wang, Camargo & Veluswamy, 2013). Use of multiple drugs is likely to increase the medication errors and likelihood of receiving unsuitable medications.
Polypharmacy among older adults results to adverse drug reactions, physical falls, and noncompliance of the medicines (Wang, Camargo & Veluswamy, 2013). These problems arise because of the changes in physiology that result further to pharmakinetic and pharmacodynamics differences. Some of the patients experience reduced blood flow due to reduced renal mass. Moreover, become old affects the capacity of liver and the measure of blood movement in the liver. This organ reduction is likely to compromise the first pass effects of medications such as opiates and warfarin (Wolters Kluwer Health, 2015). These physiological changes in relation to multiple medications results to increased adverse effects of the drugs, increased mortality cases, and reduced functional operations.
Effects of the Polypharmacy to nursing care of the Elderly
The main challenge nurses face in relation to polypharmacy is to identify the potential culprits among the older patient population (Patton, Hughes, Cadogan & Ryan, 2017). This is because the patients are the least informants and unable to provide the rationale for the present course of medications. Besides this, most of the adult patients arrive at the health facilities with multiple complications including diabetes, heart failure, and arthritis. This offers a perfect opportunity for existence of polypharmacy, especially in older adults residing in nursing homes. Copious challenges do nurses encounter as they offer medication administration for the older patients. Among them, include multiple medications, existence of coexisting illnesses and normal physiological modifications related with aging. For these reasons, nurses are called be more considerate of the factors that compel the elderly increase the risk for ADRs. They need in addition to work for care providers to guarantee patient safety in medication management. Nurses have the task of employing structures framework in assisting pharmacists reduce unnecessary adverse events, drug interactions, and unnecessary prescribing (Wolters Kluwer Health, 2015). This role can be effectively managed by obtaining an accurate medication of the patient’s medical history, relating the medication to the state of the disease, identifying medications necessary for treating side effects, and initiating interventions to ensure that the patients adhere to the drugs.
Reactions of nurses to Polypharmacy
Nurses ought to guide against the hospitalization among the elderly patients. This is because polypharmacy is a sign of increased hospitalization (Wolters Kluwer Health, 2015). It is necessary for the nurses to conduct medical review to reduce duplicate of the medications that are contraindicated for older adults. It is necessary for the patients to realize the importance of the medications and the routine of taking them. Additionally, healthcare givers should evaluate the adherence of the medications in the routines reviews and advocate for patients in the events of complicated medication regimen. This complication can be minimized by reducing the number of prescribed medications with simplified dosing schedules and guaranteeing that the right drugs are prescribed for the right circumstances. Valid and reliable tools can be utilized on conducting periodic medication assessments to reduce polypharmacy. There is the Beers Criteria can be applied, for instance, to avoid adverse effects, and reduce commonly misused clinical indication.
Impact of Polypharmacy in Nursing Care
In case polypharmacy continues, nurses are obliged to incorporate the study of polypharmacy in the nursing practice (Sganga, 2015). This study will ensure that they enhance their communication skills with the physicians and the pharmacists to prevent potential problems such as increased mortality. Nurses in addition will have to simplify the medication regimen by allowing patients take occasional drugs or involving them in activities that will trigger them take their medications.
Nursing Implications of Polypharmacy
Elderly patients are less likely to benefit from multiple treatments as compared to the younger populations. This is because they shift the attention of the care form caring to curing (Sganga, 2015). Nurses are called to identify people with multiple medications and assist in realizing their effectiveness. This role calls for obtaining a comprehensive drug history with explanations of the role of the age-related modifications on the effect of the medications on the elderly. In addition, nurses are called to exercise good palliative geriatric practice algorithm for the drug discontinuation.
Polypharmacists is among the problems nurses face among the older patients. Due to increased life expectancy, there is a high probability that nurses will continue to face the same problem for a long time. Older patients may be in need for more drugs. However, nurses are called to be cautious of the effects of polypharmacy in increased drug interactions and increased levels of hospitalization. This is especially evident among patients admitted with acute care cases.
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