NEW YORK NURSE: May 2010

Ask the Experts

Avoiding polypharmacy in older adults

By Bethel Ann Powers, RN, PhD, Professor, University of Rochester School of Nursing, Member, Central New York Nurses Center for Nursing Research, Planning Committee, Foundation of New York State Nurses

Q.: How can I recognize and help older adults at risk for serious health problems resulting from dangerous drug interactions?

A.: According to a recent study (Qato et al., 2008), a considerable increase in older Americans’ use of prescription drugs in combination with over-the-counter medications and supplements places nearly 1 in 25 individuals at potential risk for major drug interactions.

Older persons, whose bodies handle drugs differently than younger persons, are highly susceptible to dangers associated with polypharmacy, i.e., an individual’s use of multiple different medications or supplements, which increases vulnerability to harmful, even life-threatening, side effects.

Experts offer the following tips for recognizing and avoiding polypharmacy in older adults:

Assess all medications (including supplements) at every healthcare encounter. Ballentine (2008) recommends the “brown bag” approach that suggests patients bring to their next healthcare visit everything they take (e.g. prescribed and OTC drugs, vitamin and herbal supplements) in a brown paper bag.
Recognize drugs that frequently cause problems in older age groups. The best evidence-based assessment tool can be easily accessed at www.nursingcenter.com/AJNolderadults. Click on the “How to Try This” link, and scroll down to find the free demonstration video on how to use the Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. See also Molony, 2009, for the corresponding print article in the American Journal of Nursing.
Simplify drug regimens as much as possible. *In some instances, stopping medicines can be “a therapeutic maneuver” (*McCann, quoted by Rubin, 2008, in USA Today).
Encourage performance of thorough drug histories for all older persons by engaging the patient and inviting care providers or family members to help. Always ask, “Is there anything else you take?”
Recommend that patients keep up-to-date medication lists and encourage their care providers to help keep the lists current. (**Sellers, practicing Adult Nurse Practitioner)

References

Ballentine, NH (2008). Polypharmacy in the elderly: Maximizing benefit, minimizing harm. Critical Care Nursing Quarterly, 31, 40-45.

Molony, SL (2009). How to try this: Monitoring medication use in older adults. AJN, 109(1), 68-78.

Rubin, R (2008) Mixing drugs puts older patients at risk. USA Today
http://www.usatoday.com/news/health/2008-12-23-mixing-drugs_N.htm Qato, DM, Alexander, GC, Conti, RM, Johnson, M, Schumm, P, & Lindau, ST (2008).

Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA, 300, 2867-2878.

* Robert McCann MD, Professor of Medicine, University of Rochester School of Medicine and Dentistry and Chief of Medicine at Highland Hospital, Rochester, NY
** Craig Sellers PhD, RN, ANP-BC, Associate Professor of Clinical Nursing and Specialty Director, Adult Nurse Practitioner Program, University of Rochester School of Nursing, Rochester, NY

This is a sample of the questions NYSNA’s experts answer each day. The advice given is specific for the situation described and may not be applicable generally. If you have questions about your own work setting, it is recommended that you contact your NYSNA Nursing Representative or the Education, Practice, and Research Program, 11 Cornell Road, Latham, New York 12110-1499 or call 800-724-NYRN, ext. 282.