Winter 2023 Newsletter
Mark Foster, DNP, APRN, FNC-BC, & Randi Davis, DNP, APRN, FNP-BC
College of Nursing and Health Professions
Arkansas State University
Polypharmacy in the older population continues to be prevalent across the state of Arkansas and nationally as well. The definition of polypharmacy varies depending on the source; however, on average, polypharmacy is defined as the use of five or more prescription drugs. According to the Centers for Disease Control and Prevention (CDC), “nearly 7 in 10 adults aged 40–79 used at least 1 prescription drug in the past 30 days in the United States (69.0%) and Canada (65.5%), and around 1 in 5 used at least 5 prescription drugs (22.4% in the United States and 18.8% in Canada)”, (CDC, 2019). Additionally, “The prevalence of polypharmacy has been reported to be approximately 40% with a third of residents in long-term facilities using 9 or more medications,” (Hawthorne et al., 2017). The Arkansas Department of Health Office of Long-term Care reports more than 23,000 Arkansans receive services in long-term care facilities each year, (Arkansas Department of Health, n.d.). Therefore, this underscores the significance of the potential impact on elderly Arkansans.
Polypharmacy increases the risk of adverse drug reactions, drug interactions, cognitive impairment, increased fall risk, and duplicate therapy. Coleman (2022) indicated the likelihood of hospitalization is 34% in patients taking 5-9 medications, and the likelihood of hospitalization increases to 98% in patients taking 10 or more medications. A recent study indicated the most commonly consumed prescription medications among our elderly were those prescribed for cardiovascular health and mental health (Hawthorne et al., 2017). These findings are not surprising considering that heart disease is the leading cause of death in the United States. Therefore, careful consideration of prescribing patterns is essential, particularly for antihypertensives, anticholinergics, and antidepressant medications.
Furthermore, frailty has also been associated with polypharmacy. Frailty is defined as, “a complex geriatric syndrome resulting in decreased physiological reserves,” (Gutiérrez-Valencia et al., 2018, p. 1433). A systematic review of 25 quantitative studies analyzed the relationship between polypharmacy and frailty among the elderly population and found a significant association. Therefore, strategies to decrease polypharmacy could also be utilized in an effort to prevent and manage frailty (Gutiérrez-Valencia et al., 2018).
Strategies for mitigation of polypharmacy in primary and long-term care include the utilization of evidenced-based instruments and adherence to recommended criteria. Instruments may include the STOPP (Screening Tool of Older Person’s Prescriptions) and START (Screening Tool to Alert doctors to Right Treatment) tools. The Beers Criteria has been widely accepted as a useful resource, listing medications that should be avoided in the elderly population. In addition, the Medication Appropriateness Index (MAI) may be applied to assess the appropriateness of medications prescribed for elderly patients.
Healthcare providers in are in a strategic position to initiate and monitor deprescribing practices, particularly regarding the geriatric population with multiple medication regimens, (Diggins, 2019). It is vital for all members of the healthcare team including primary care providers, mental health providers, pharmacists, social workers, and nurses to work collaboratively to optimize the plan of care for elderly patients. Accurate medication reconciliation and maximization of the capabilities of electronic medical record systems to include interfacing between primary, acute, and long-term care settings is paramount to the success of this collaborative effort.
The average life expectancy for Arkansans as of 2020 is 73.8 years (CDC, 2022). As the aging population continues to increase, incidence of health conditions requiring medical management among elderly Arkansans will continue to rise. Therefore, healthcare providers in Arkansas must be committed to employing the above mentioned strategies in order to decrease the prevalence of polypharmacy and its associated detrimental effects.
References:
Arkansas Department of Health. (n.d.). Office of long term care. Retrieved January 12, 2023, from https://humanservices.arkansas.gov/divisions-shared-services/provider-services-quality-assurance/office-of-long-term-care/
Centers for Disease Control and Prevention. (2022). Life expectancy at birth by state. Retrieved January 17, 2023, from https://www.cdc.gov/nchs/pressroom/sosmap/life_expectancy/life_expectancy.htm
Centers for Disease Control and Prevention. (2019). Prescription drug use among adults aged 40-79 in the United States and Canada. Retrieved January 12, 2023, from https://www.cdc.gov/nchs/products/databriefs/db347.htm#ref1
Coleman, B. (2022). Polypharmacy: Is It the new normal for the elderly patient? CEUfast. Retrieved January 12, 2023, from https://ceufast.com/course/is-polypharmacy-the-new-normal-for-the-elderly-patient
Diggins, K. (2019). Deprescribing: Polypharmacy management in older adults with comorbidities. The Nurse Practitioner, 44(7), 50-55. https://doi.org/10.1097/01.NPR.0000554677.33988.af
Gutiérrez-Valencia, M., Izquierdo, M., Cesari, M., Casas-Herrero, A., Inzitari, M., & Martínez-Velilla, N. (2018). The relationship between frailty and polypharmacy in older people: A systematic review. British Journal of Clinical Pharmacology, 84(7), 1432-1444. https://doi.org/10.1111/bcp.13590
Hawthorne, J., Warford, L., Hutchison, L., Pangle, A., Price, E., Wei, J., & Azhar, G. (2017). Prescription medication use in the oldest old of south-central United States. American Research Journal of Geriatrics and Aging, 1(1), 1-10.