Elderly - Drugs and Polypharmacy - Part 1 Flashcards
what is polypharmacy
Not an agreed definition
Just means many medications
Polypharmacy = many drugs
Even one drug prescribed inappropriately
Why learn about adverse drug reactions (ADRs)?
- Over 2 MILLION serious ADRs yearly (USA)
- 100,000 DEATHS yearly
- ADRs 4th leading cause of death ahead of pulmonary disease, diabetes, AIDS, pneumonia, accidents, and automobile deaths
- Ambulatory patients ADR rate – unknown
- Nursing home patients ADR rate – 350,000 yearly
Polypharmacy often leads to ____
So many it is hard to identify when a symptoms is caused by an ___
___ of hospitalised people get an ADR during their stay
ADRs
ADR
15%
what is the relationship between adverse drug reactions and polypharmacy?
are ADRs preventable? and if so how many are preventable?
yes
- Nearly one third of adverse drug events in ambulatory settings are preventable
- Half of adverse drug events in nursing facilities are preventable
ther eis lots of different ADRs
what are some common iatrogenic drug problems?
- Confusion, dry mouth, constipation, blurred vision, urinary retention and orthostatic hypotension with anticholinergics
- Confusion and unsteady gait with tricyclics
- Digoxin toxicity with normal serum concentrations
- CNS toxicity with long-acting benzodiazepines
- Confusion with narcotics
what are some Costly medication-related problems/ADRs in older patients?
- Falls
- Cognitive Loss /delirium
- Dehydration
- Incontinence
- Depression
- End result can be:
- Loss of functional capacity
- Poor quality of life
- Nursing home placement
Lead to geriatric giants
prescriptions and older adults:
•Older adults (age>50) get 2-3 times as many prescriptions
- 12% of population; > 32% of prescription drugs
•Typical 85yr old older adult takes 8-9 prescriptions and 2 OTC drugs at once
why?
- More acute & chronic disease
- More doctors visits
- Drugs often given to counteract a side effect of another drug
- Several other factors arising from prescribers, patients and the system
ADRs can be dismissed as part of old age and then often being prescribed more drugs for these new problems but actually you should be stopping it
Adverse drug reactions look like “growing old” - what are some of the effects that may look like this?
- Unsteadiness
- Dizziness
- Confusion
- Nervousness
- Fatigue
- Insomnia
- Drowsiness
- Falls
- Depression
- Incontinence
what is the Prescribing Cascade?
Can lead to 7-8 drugs but all you needed to do was change drug 1
Medical conditions might have different presenting signs and symptoms in elderly patients
this is how hyperthyroidism would present in a young patient:
- Tremor
- Anxiety
- Weight loss
- Diarrhoea
how would it present in an elderly patient:
- Depression
- Cognitive impairment
- Muscle weakness
- Atrial fibrillation
- Heart failure
- Angina
(Misdiagnosis is another key cause of polypharmacy)
_________ drive polypharmacy
We focus too much on a _______ centred approach
guidelines
disease
- Cross-referenced NICE guidelines for T2DM, Depression, Heart failure with 11 other disease specific guidelines:
- T2DM – 133 drug-drug interactions
- Depression – 89 DDIs
- Heart Failure – 111 DDIs
what are osme Healthcare provider factors that
contribute to polypharmacy?
- No med review with patient on regular basis - Nobody stops to say how many medications has MR X accumulated at the age of 80
- Presumes that patient expects meds
- Prescribes without sufficiently investigating clinical situation (maybe due to time pressure)
- Evidence that a particular drug is the “best” drug for a problem - Complicated by the existence of many problems and multiple providers
- Provides unclear, complex or incomplete instructions about how to take meds
- No effort to simplify medication regimen
- Ordering automatic refills
- Lack of knowledge of geriatric clinical pharmacology
Patient may see many different health professionals, get nervous about stopping a drug that someone else has started
