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The Dangers of Polypharmacy

The Dangers of Polypharmacy. Debra Brown Patrick Campbell Georgia Daniels NSG 334-800. Ages 65 or older Fastest growing age group (Hajjar, Cafiero, & Hanlon, 2007) Multiple medical conditions. Elderly. Polypharmacy. Definition

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The Dangers of Polypharmacy

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  1. The Dangers of Polypharmacy Debra Brown Patrick Campbell Georgia Daniels NSG 334-800

  2. Ages 65 or older Fastest growing age group (Hajjar, Cafiero, & Hanlon, 2007) Multiple medical conditions Elderly

  3. Polypharmacy • Definition • Multiple medications or more medications than necessary (Hajjar, Cafiero, & Hanlon, 2007) • Problems (Hajjar, Cafiero, & Hanlon, 2007) • Inappropriate medications • Drug-drug interactions • Duplication of therapy • Nonadherence • Adverse effects

  4. Why does polypharmacy affect the elderly? • Increasing number of chronic conditions • Multiple prescribing physicians • Availability of non-prescription drugs • High cost of prescription medications • Hoarding of old prescriptions • Inadequate knowledge of medications and medical conditions • Pharmacy shopping • Romana et al, 2012

  5. Adverse Drug Reactions • Commonly seen in the elderly due to age related changes in absorption, metabolism, and excretion. • The stomach, skin, liver and kidney are all affected by age and this changes how the body responds to medications. • Inappropriate prescribing of medications is also a contributing factor to the increased chance of adverse drug reactions. • One forth of the adverse drug reactions are due to inappropriate prescriptions. • Romana et al, 2012

  6. Incidence • Elderly women in the United States (Hajjar, Cafiero, & Hanlon, 2007) • 57% use 5 or more medications • 12% use 10 or more medications • Elderly patients in the United States (Hajjar, Cafiero, & Hanlon, 2007) • 90% use more than 1 OTC medication • 50% use 2-4 OTC medications

  7. Incidence Cont. • In Europe, 22% of home care patients take 9 or more medications. • Finland has a 41% rate • Czech Republic 39%(Fialová & Onde, 2009)

  8. Hospital Based Study in India • 100 elderly inpatient participants who were age 60 or older, each taking at least 5 drugs • 38% of patients received 9 or more drugs • 24% of patients received 7 or more drugs • Respiratory disorders, followed by cardiovascular disorders were most associated with polypharmacy • Only 4.27% of drugs were prescribed in generic name • Only 2.37% of prescribed drugs were inappropriate according to Beer’s list • Romana et al, 2012

  9. Unnecessary Drug Use • Medication Appropriateness Index • Suboptimal medications • Taking medications without indication • Ineffective medications • Therapeutic duplication (Hajjar, Cafiero, & Hanlon, 2007)

  10. Risk Factors • Demographic • Elderly, Caucasian, education (Hajjar, Cafiero, & Hanlon, 2007) • Health Status • Depression, poor health, >9 medications, HTN, anemia, asthma, DM, gout, osteoarthritis, angina (Hajjar, Cafiero, & Hanlon, 2007) • Access to Health care characteristics • # of health care visits, supplemental insurance and multiple providers (Hajjar, Cafiero, & Hanlon, 2007)

  11. Comorbidities • Many elderly have multiple diagnoses • Medications for one condition may exacerbate another or interfere medications may interfere with each other

  12. Multiple Physicians • Many patients will see a specialist for each condition • Poor communication and drug review leads to duplicate therapies or interactions • Prescribers add medications treating effects of current medications(Fialová & Onde, 2009)

  13. Dearth of Research • Studies don’t use patients reflective of who would normally use the drug • Heart failure test subject 63 years old • Heart failure medication use 74 years old • Prevalence of depression is highest in older patients but <10% of clinical trials include them(Fialová & Onde, 2009)

  14. Research Issues cont. • Lack of research using elderly due to: • Comorbidities • Polypharmacy

  15. Consequences • Adherence • Inappropriate Prescribing • Adverse Drug Reactions • Geriatric Syndromes • Morbidity/Mortality (Hajjar, Cafiero, & Hanlon, 2007)

  16. Interventions • Medication Review • Nonpharmacologic therapy • Education • Generics • Limiting PRN medications • Simplifying dosage instructions

  17. References • Hajjar, E. R., Cafiero, A. C., & Hanlon, J. T. (2007). Polypharmacy in elderly patients. The American Journal of Geriatric Pharmacotherapy 5(4), 345-351. • Fialová, D., & Onde, G. (2009). Medication errors in elderly people: contributiing factors and future perspectives. British Journal of Clinical Pharmacology, 641-645. doi:10.1111/j.1365-2125.2009.03419.x

  18. Romana, A., Kamath, L., Sarda, A., Muraraiah, S., Cr, J. (2012). Polypharmacy leading to adverse drug reactions in elderly in a tertiary care hospital. International Journal of Pharma and Bio Sciences, 3(3) 218-224. Retrieved from: www.ijpbs.net.

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