Polypharmacy and the elderly

Polypharmacy represents an issue of concern that needs to be discussed and addressed for the safety of a fragile and vulnerable population, the geriatric population. According to Maher, Hanlon, and Hajjar (2014), about 50% of geriatric patients ingest more than one medication that is not medically necessary, especially patients living in nursing home facilities. The creation of a policy that moderates, rectifies or eliminates the use of multiple pharmacological agents among the geriatric community would positively impact the healthcare delivery system and safety of these patients.

Is there a Polypharmacy Policy in place?

No, that is why the creation of one represents such a pressing concern. The creation of a policy directed towards reducing the use of polypharmacy among elderly patients would include goals involving the prevention of medication duplicates, appropriateness of drug prescription for this particular age group and risk assessment involved with prescribed medication. Currently, there are no standardized guidelines to direct clinicians in the prevention of polypharmacy in the geriatric field. According to Skinner (2015), the creation of a simple, time-efficient screening protocol that can be utilized on an everyday basis is imperative for the safety of elderly clients in the primary care setting. The utilization of such tool would prevent adverse drug episodes, falls, and hospitalizations. While maintaining lower healthcare costs.

Currently, the Beers criteria is the most useful tool to monitor the use of multiple drugs among the elderly population. The Beers criteria can be used as a clinical practice guideline and a quality assurance review. There are 30 factors involved in the Beers criteria, helpful in determining appropriateness of certain medication such as antidepressants, antipsychotics, sedatives, among other; Beers et al. (1991). Surprisingly, after 27 years the Beers criteria is still the only guideline-type of document addressing polypharmacy among the geriatric population. With the elderly population expected to grow, the creation of a standardized protocol or policy directed towards resolving the issue of polypharmacy would seem like a pivotal accomplishment for such a time as this.

Who should be involved?

The development of a new polypharmacy policy should engage the public and government authorities to promote change. Additional factors to consider in the development of a new polypharmacy policy are incidence of the problem, mortality, community involvement, and healthcare proposed solution. As mentioned by Arnoldo, Cattani, Cojutti, Pea, and Brusaferro (2016) data collection and medication classification can benefit the geriatric population and assist in the prevention of polypharmacy.

Worldwide Initiative

To assist in simplifying the prescriptive process in the region of Friuli Venezia-Giulia in Italy, Arnoldo and colleagues classified medications based on the Anatomical Therapeutic Chemical (ATC) and formulated a classification system. According to Arnoldo et al. (2016), exposure to medication can be stratified into three classes: from 1 to 4, from 5 to 9 (polypharmacy) and 10 or more (hyper-polypharmacy). This methodology can easily assist clinicians in the careful consideration of medications being administered to the geriatric population.

Another study conducted in Sweden analyzed the prescribed drug expenditure in direct relation to polypharmacy practices. According to Hovstadius and Petersson (2012), the prevalence of polypharmacy increased by 8.3% between the years 2005 and 2009, leading to a direct increase of 4.8% in the prescribed drug expenditure for that time period. The authors recommend careful consideration when it comes to polypharmacy and the costs associated with it. Research performed in other countries can yield common areas of concern and promote the development of a worldwide standardized guideline, useful in preventing polypharmacy in the geriatric population.



References

Arnoldo, L., Cattani, G., Cojutti, P., Pea, F., & Brusaferro, S. (2016). Monitoring Polypharmacy in Healthcare Systems Through a Multi-Setting Survey: Should We Put More Attention on Long Term Care Facilities? Journal of Public Health Research, 5(3), 745.

Beers MH, Ouslander JG, Rollingher I, Reuben DB, Brooks J, Beck JC (1991). Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home Residents. Arch Intern Med;151(9):1825–1832.

Hovstadius, & Petersson. (2012). The impact of increasing polypharmacy on prescribed drug expenditure—A register-based study in Sweden 2005–2009. Health Policy, 109(2), 166-174.

Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical Consequences of Polypharmacy in Elderly. Expert Opinion on Drug Safety, 13(1).

Milstead, J.A. (2016). Health policy and politics: A nurse’s guide. Burlington, MA: Jones & Bartlett Learning.



Skinner, M. (2015). A literature review: Polypharmacy protocol for primary care. Geriatric Nursing, 36(5), 367-371.