Running Head: POLYPHARMACY AMONG ELDERLY 1

Polypharmacy among the Elderly
During my first week of clinical I cared for a lovely woman who suffers from many
chronic diseases and such is prescribed medications to treat her various conditions. Among her
comorbidies are hypertension, atrial fibrillation, chronic kidney disease, spinal stenosis,
depression, and dyslipidemia. For these diseases she is taking seven medications. In total she had
twelve scheduled medications per day, among them three to treat hypertension alone.
This patient is in no way unique. The number of medications prescribed to older adults
and the elderly is often outlandish, numbering upwards of ten or more on a scheduled basis.
Polypharmacy can be defined as greater than five medications (RNAO, 2005; Liu, 2014) or as
taking more medications than medically necessary (Maher, Hanlon, & Hajjar, 2014).
Administration of this many medications at a given time requires great understanding of the
mechanism of action of each drug as well as their individual side effects and all possible
interactions. As a nursing student, having to research many medications for a single patient and
understand them can be challenging, and to me having to do this for many patients even more so.
The effect on me as a nursing student pales in comparison to the effects on the elderly. Drug
metabolism and excretion slows creating the potential for harmful effects from one drug alone
but it also creates greater potential for harmful interactions among drugs (Maher et al., 2014).
I feel that most of the aging population today come from a generation that views
physicians as trustworthy individuals who are concerned with doing what is best for them and as
such follow most directions offered to them by physicians especially when concerned with
medications. They do not question why a medication is being prescribed or what it does because
they feel they should not question the doctor who knows more than them as someone in my
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generation might. As I might question and research the prescription of a new drug, they just take
it believing it to be of benefit to them. This blind trust of the elderly can lead to polypharmacy
and to unnecessary harm from not understanding the medications they are on.
It seems unnecessary for a single person to be on many medications to treat a disorder at
any age, unless warranted by the nature of the disease (i.e. TB or HIV). The presence of many
chronic diseases however, may necessitate the prescription of medications to treat each disorder
which may add up over time (Liu, 2014). In this situation I feel it is necessary to be aware of
why each medication is being prescribed and the effect it may have on an individual and to
educate the patient to a level where they understand their risk. Polypharmacy has been associated
with negative outcomes such as falls, which may lead to fractures and hospitalization, and
potentially death (RNAO, 2005; Liu, 2014). Polypharmacy itself may lead to hospital visits due
to adverse drug reactions and interactions (Maher et al., 2014). Functional status (including
urinary incontinence) and cognitive decline are also associated to the over use of medications
(Maher et al., 2014). So it is important to help a patient understand their risk as well as track the
medications they are on if they are exposed to a number of different prescribing physicians. As
nurses, we should as be advocating on behalf of our patients the removal of medications that
could be considered unnecessary.
Research tells us that half of older adults take at least one medication that is not required
to promote health and that polypharmacy is associated with negative outcomes (Maher et al.,
2014). Along with the outcomes listed above, polypharmacy is also associated with non-
adherence among elderly due to the complicated nature of their medication regimes (Maher et
al., 2014). Deprescribing medications is often overlooked as many factors lead it to being time
consuming (Liu, 2014). One of these factors is the preference of the patient and/or their family
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who might perceive the act of removing medications as inferior care (Liu, 2014). Also some
prescribers may be concerned with the harm that removing medications from a regime might
result in if not convinced the medication is doing harm, however, if the medication is not
effective it is probably best to remove it from the patients treatment regime (Liu, 2014).
As the population continues to age the rate of polypharmacy is likely to also rise unless
some intervention is taken. Being aware of the impact polypharmacy has on the overall health of
an individual as well as on the healthcare system puts nurses in a place to act to limit the
negative effects of polypharmacy. It is within our scope of practice to help physicians assess
which medications are worthy of deprescription and within in our scope to explain the necessity
of this action to families and patients.
References
Registered Nurses’ Association of Ontario. (2005). Prevention of falls and fall injuries in the
older adult. Toronto, Canada: Registered Nurses’ Association of Ontario
Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in
elderly. Expert Opinion on Drug Safety, 13(1). doi: 10.1517/14740338.2013.827660
Liu, L. M. (2014). Deprescribing: An approach to reducing polypharmacy in nursing home
residents. The Journal for Nurse Practitioners, 10(2), 136- 139. Retrieved from:
http://www.npjournal.org/