Running head: POLYPHARMACY

Polypharmacy

Nicholas Neme

Regis College
SYPHILIS 2

Polypharmacy

Polypharmacy refers to the overuse of medications in patients and is more common in the elderly
due to co-morbidities (Rochon, 2019). In older patients, polypharmacy is particularly dangerous
because it can lead to adverse drug events due to poor drug clearance, greater potential for drug
on drug interactions, increased risk for falls, prescribing cascades, and a decrease in medication
compliance due to multiple medications (Rochon, 2019). Creatinine clearance slows with age
making drug processing time and half-life longer in elderly patients and, as a result, drugs remain
in the body longer (Steinman & Reeve, 2020). When drugs stay in the system longer patients are
at an increased risk for adverse effects and drug on drug interactions. Taking multiple
medications a day can be discouraging and lead to decreased adherence to drug therapies.
Decreasing polypharmacy in the elderly can simplify medication regimens and increase overall
compliance.

Advanced practice nurses can engage in routine deprescribing through discussions with patients
about care goals during annual examinations. One method of addressing this is medication
review and the practice of deprescribing of inappropriate or unnecessary medications.
Deprescribing is the process of evaluating a patient’s medications for efficacy and polypharmacy
in order for supervised withdrawal of prescription medications (Steinman & Reeve, 2020). The
goal of deprescribing is to reduce medication use, lower fall risk, improve cognitive functioning,
and reduce the risk of hospitalization or death (Steinman & Reeve, 2020). Shared decision
making and collaboration with other practitioners are important aspects of the deprescribing
process (Steinman & Reeve, 2020). Beers criteria should also be used during prescribing
practices to determine the appropriateness of drugs in elderly populations and prevent
polypharmacy (Rochon, 2019).

Physicians prescribing to elderly patients should consider the cost-benefit analysis of

medications and align treatment regimens with patient goals. Nonpharmacologic approaches
should be encouraged if possible, doses should be started out lower, and dose schedules should
be simplified for ease of care (Rochon, 2019). Nurse practitioners should always ask about
alternate or herbal therapies because some patients may not consider these medications (Rochon,
2019). Longer appointment times for elderly patients may help alleviate the time burden of a
medication review (Cantlay, Glyn, & Barton, 2016). In complicated cases, patients should be
scheduled for a separate appointment to review medications and allow for a multi-disciplinary
approach (Rochon, 2019). Patients should be encouraged to make an appointment with primary
care practitioners following hospitalization because of the possibility of additional medications
(Cantlay et al., 2016). Polypharmacy is a complex issue in the elderly however safe prescribing,
frequent review of medications, and multidisciplinary communication can reduce the prevalence
of this problem.

References

Cantlay, A., Glyn, T., & Barton, N. (2016). Polypharmacy in the elderly. InnovAiT, 9(2), 69–
77. https://doi.org/10.1177/1755738015614038.
SYPHILIS 3

Rochon, P. A. (2019, August 15). Drug prescribing for older adults. Retrieved March 5, 2020,
from https://www-uptodate-com.regiscollege.idm.oclc.org/contents/drug-prescribing-for-older-
adults?search=polypharmacy in
geriatrics&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1.

Steinman, M., & Reeve, E. (2020, January 21). Deprescribing. Retrieved March 5, 2020, from
https://www-uptodate-com.regiscollege.idm.oclc.org/contents/deprescribing?
search=polypharmacy in
geriatrics&source=search_result&selectedTitle=5~150&usage_type=default&display_rank=5.