Polypharmacy Free Essay Samples & Outline

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Sample Essay On POLYPHARMACY


Poly-pharmacy refers to the use of multiple medications or the use of medicine that is not indicated for a disease condition or the ineffective or inappropriate use of medications than they are medically necessary (Hilmer et al. 2009). The use of medicines that constitute therapeutic duplication also amounts to Poly-Pharmacy (Robert et al. 2014). A rise in life expectancy in many regions around the world has resulted in the number of people aged 65 years and above.

Older people are more likely to suffer from multiple disease conditions like hypertension, diabetes, cardiovascular diseases, arthritis, and cancer. These conditions require multiple drug therapies for their management and treatment (Hilmer et al., 2004) Poly-pharmacy is, therefore, very more prevalent in older adults. Self-medication and self-prescriptions of drugs and a prescribing cascade also cause poly-pharmacy. A prescribing cascade entails patients take medications and then exhibit the side effects, which are then misinterpreted by the health care professional as a disease symptom. Ineffective communication and coordination between the patients and the health care provider resulting in multiple prescriptions in different healthcare settings is also a major cause of Poly-Pharmacy (Lisa 2008).

In ambulatory care, poly-pharmacy happens when the prescribed medicines are five or more than five types of medicines (Robert et al. 2014). However, current medical practices guidelines usually require multiple medications to treat every condition for optimal clinical benefits and, therefore an elderly patient with two or more disease conditions usually exceeds the ambulatory threshold of fewer than five medications (Richard, 2007).

The degree of poly-pharmacy is influenced by the factors such as age, the natural progression of the disease, hospitalizations or care settings for the elderly (Richard, 2007). According to a survey carried out by Qato et al. in 2006, 37 percent of men and thirty-six percent of women aged 57-85 years of age in the survey used more than five types of medications. The most common type of medications involved in cases of poly-pharmacy are prescription medicines, over the counter medications and dietary supplements (Hilmer et al. 2009). Nearly fifty percent of all old people take one or more type of unnecessary medications (Lisa, 2008).

Whereas poly-pharmacy can be therapeutic and effective in the treatment of multiple illnesses in the elderly, Research has, Clearly established a very robust relationship between poly-pharmacy and some negative clinical consequences (Ann et al. 2003). This review details the adverse health outcomes of poly-pharmacy in old people and highlights the interventions for improving medication use by old people.

The Negative consequences of Poly-pharmacy on older people


1) Adherence

Old patients are at high risk of receiving inappropriate medication and increased cases of adverse drug reactions that influence a patient’s adherence to their medication regimes. Adverse drug reactions result in patients avoiding following the drug intake regimes (Hilmer et al., 2009). Poly-pharmacy results in complex medication regimes that make non-adherence a very common problem among old people with a prevalence rate of fifty percent for the elderly population (Robert et al. 2014).

2) Adverse drug reactions and inappropriate prescribing

Multiple drug prescriptions increase the risk of inappropriate prescriptions that result in adverse drug reactions. Adverse drug reactions increase with an increase in the number of medications taken (Richard, 2007). Adverse drug reactions occur in five to thirty percent of outpatient hospital visits and account for twelve percent of all hospital admissions (Robert et al. 2014).

The risk for development of adverse drug reactions is strongly linked with multiple comorbidities and poly-pharmacy. Lisa (2008) explains that as the body ages, it processes medicines differently. Medicines also stay in the body for longer periods and medicines are highly concentrated in some specific parts of the body due to diminished circulation and reduced cardiac output. Reduced renal and liver functions also influence how drugs are metabolized making old people at a very high risk of suffering from adverse drug reactions (Lisa 2008).

Ann et al.(2003) also explain that delayed stomach emptying and the reduced ratio of body fat to water may also result in altered bio-physiology that make old people unable to tolerate the prescribed medications and experience side effects and adverse drug reactions. Hilmer et al. (2009) assert that the most common drugs associated with adverse drug events in the elderly are anti-coagulants, NSAIDS, Diuretics, Cardiovascular Medications, Antibiotics, Diabetic Medications, Anticonvulsants, and Benzodiazepines.

3) Drug interactions

Old people are more predisposed to drug interactions (Dementra, 2012). The probability of drug interactions increases with an increase in the number of medications with a fifty percent risk when a patient is taking five to ten medications and a 100 percent risk when a patient is taking more than twenty medicines. Many patients are living longer with chronic disease conditions requiring multiple drug therapy, and the risk of drug interactions is a major concern for healthcare professionals (Robert et al., 2014).

4) Geriatric syndromes

Multiple medications are linked to many geriatric issues like urinary incontinence and increased risk of suffering from lower urinary tract infections. Other geriatric syndromes are cognitive impairment and loss of balance that results in fractures and falls (Hilmer et al. 2009).


5) Effects on Morbidity and functional status

Poly-Pharmacy can help in controlling the multiple comorbidities in old people, but it is associated with a decline in the functional status of individuals. Poly-pharmacy usually results in a reduction in the abilities to perform the instrumental abilities of daily living (IADL) and a decrease in the physical functioning of individuals (Robert et al., 2014).

6) Falls

Falls are associated with the reduced morbidity in older people and may be enhanced by taking of certain medications especially the psychotropic and Central nervous system medications. People taking more than two psychotropic agents have a 2 to four-fold risk of falling compared to those taking just one psychotropic agent (Hilmer et al. 2009). As an independent variable, poly-pharmacy appears to be linked to an increase in the risk of falls in old people, but the type of medications taken determines the link between poly-pharmacy and falls. Poly-pharmacy is also a risk factor that exacerbates falls and it is synergized by the other factors associated with poly-pharmacy such as drug -drug interactions and the drug-disease interactions (Ann et al. 2003). Studies have indicated that taking four or more than four types of drugs is associated with increased risk of mild, injurious, and recurrent falls (Zia et al. 2015).


7) Increased healthcare costs

Poly-pharmacy results in an increase in healthcare costs for the patient and the healthcare system (Hilmer et al. 2009: Robert et al., 2014). Some data suggest that poly-pharmacy results in an increase in healthcare costs by thirty percent, due to potentially inappropriate medication prescribing, increased hospital visits and the associated adverse drug reactions associated with poly-pharmacy (Richard, 2014)


9) Effects on Nutrition and feeding patterns

Poly-pharmacy also affects a patient’s nutritional status. Patients taking more than ten medications have poor nutrition and a risk of malnutrition (Robert et al., 2014). Adverse drug effects may also affect the appetite of patients resulting in poor eating habits such as taking unhealthy and unbalanced diet (Ann et al., 2003).

10 Effects on Mortality

Poly-pharmacy is also associated with increased risk of mortality in old patients (Emily, 2007). The adverse medication outcomes associated with multiple drug prescriptions in hospitals is the fourth leading cause of mortality in hospitals (Dementra, 2012).

10) Cognitive impairment

Poly-pharmacy is also associated with an increase in the risk of development of mild cognitive impairments, which is a syndrome characterized by a cognitive decline, which is greater than the age of an individual, education, and a reduction in the ability to do the activities of daily life (Gonzalez, 2014). Cognitive impairments such as deliriums and dementia are also associated with poly-pharmacy. The risk of suffering from deliriums increases with an increase in the number of medications taken (Hilmer et al., 2009). Mild reduction in the cognitive function occurs due to a combination of factors. These factors are reduced, physical activity, comorbidities and declining executive functions associated with age and the use of different and in-appropriate drugs in elderly patients. Poly-pharmacy can exacerbate the decline in the cognitive function of the elderly in the different cognitive domains and the functional independence of a person (Gonzalez 2014).

Poly-pharmacy has some severe negative effects on the health of old people. Health care professionals should lead the fight of this silent epidemic. The strategy that health care professionals can use to reduce cases of poly-pharmacy in old people is a better review of medicines at the time of prescriptions to ensure only the required medicines are administered. Better communication and coordination with old people in the management of multiple illnesses, and educating and supporting patients in self-medication can also help in reducing cases of Poly-pharmacy (Ann et al. 2003).


References

Ann, B. Liz, D. Gillian, L. (2003). ‘Poly-pharmacy and older people.’ Nursing Times, Volume 99, no, 17 (2).1-4.
Dementra, EA. (2012). Poly-pharmacy: A modern day silent epidemic- Signs and symptoms.
Emily, RH. Angela, CC. Joseph, TH. ‘Poly-pharmacy in elderly patients.’
The American Journal of Geriatric Pharmacotherapy, Volume 5, Number 4, 345-352
Gonzalez XA. (2014). "Cognitive decline and poly-pharmacy in an elderly population." Dissertations Paper 517. Retrieved from
Hilmer, SN, Gnjidic D. (2009). ‘The effects of poly-pharmacy in older adults.’ Discovery, Volume 85(1), 84-86.
Lisa, P (2008). ‘Poly-pharmacy and aging: is there cause for concern.’ Gerontology Update 6,
Richard, F., (2007). Poly-pharmacy and the elderly.’ Geriatric Medicine Journal, 41-47.
Robert, LM. Joseph TH, Emily RH (2014). ‘Clinical consequences of poly-pharmacy in Elderly.’ Expert Opin Drug Saf. ; 13(1): 10.1517-1534
Qato DM, Alexander GC, Conti R. (2008). ‘Use of prescription and over-the-counter
Medications and dietary supplements among older adults in the United States.’ AMA; 300:2867–2878.
Zia, A. Kamaruzzaman, SB. Tan MP. (2015). ' Poly-pharmacy and falls in older people: Balancing evidence-based medicine against falls risk.’ Postgrad Med.127 (3) 330-337.