1 / 18

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

hester
Download Presentation

The Dangers of Polypharmacy

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  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.

More Related