Polypharmacy and the Older Adult

Summary: Polypharmacy, defined as the concurrent use of several drugs, is not uncommon in the elderly. The elderly use more drugs than younger people and often require multiple medications, increasing the potential for adverse reactions, drug interactions, and self-medication errors. Additionally, PRN orders, verbal orders and unexpired orders pose additional threats. Health risks associated with polypharmacy and the escalating costs of medications require that the elderly have necessary and effective drug treatment at reasonable cost with decreased risk and maximum benefit.

Older patients with multiple disease states, altered ability to metabolize and excrete drugs, sensory and cognitive deficits and often complex medication regimens present a challenge to clinicians prescribing and to nurses administering medications. Additionally, multiple-drug use increases the risk of adverse drug reactions and interactions. These reactions may be manifested by a confusional state, a depression, suicidal ideation, an arrhythmia, disturbance in balance, a fall, increased blood pressure, gastric ulcer formation and many others.

A statement on polypharmacy is needed at this time, in order to:

• promote periodic evaluation of drugs for efficacy
• reduce adverse drug reactions
• heighten awareness of health professionals regarding principles of geriatric prescription
• deter unnecessary administration of multiple drugs.

The American Nurses Association acknowledges that many elderly, by virtue of co-existing chronic disease states, require multiple drug therapy. They also support effective and safe use of drug therapy for the older adult resulting from collaborative efforts of those who prescribe, those who administer and those older adults taking the drugs. Older adults are to be informed consumers when medications are prescribed or when taking over-the-counter medications. In order for this to occur, older individuals must be told about the direct effect of the drug, its potential side effects and possible interactions to observe when taking additional medications.

Research in geriatric/ gerontology has indicated that a judicious approach to medication administration should be used with elderly patients. To deter the use of multiple drugs unnecessarily, to evaluate appropriateness of therapy, to minimize adverse drug reactions and drug/ drug interactions and therapeutic duplications, the American Nurses Association advocates that older adults receive the fewest number of necessary drugs. Because of the potential problems with complex medication regimens, only licensed personnel under the supervision of a registered nurse or pharmacist should administer and document effects of all medications.

The American Nurses Association supports:

• the position that a drug profile be initiated on admission of older adults to any health care institution or community setting
• the evaluation/ monitoring of this drug profile for unnecessary and excessive drugs by appropriate professionals
• nurses in their actions to communicate, document, and refuse to give medications that in their judgment may adversely affect their older patients
• research in pharmacodynamics and promotion of safe medication self-administration in the older population.

Rationale

The exact relationship between the age of a client and drug interactions is unknown. However, since the elderly use more drugs than younger people and often require multiple drugs, the potential for adverse drug interactions increases. In 1988, The Food and Drug Administration reported that 33,000 deaths were attributed to adverse drug reactions and interactions.

THIS INFORMATION COPYRIGHT 1997 AMERICAN NURSES ASSOCIATION

Return to the index of position statements.