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Understanding the Medication List and Addressing Polypharmacy in Older Adults

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Abstract

Polypharmacy is a common issue when caring for older adults. Albeit clinically justified for some patients, it is critical that the interprofessional team constantly reevaluates the patient’s medication list to minimize negative consequences such as adverse drug events or prescribing cascade. There are many reasons polypharmacy occurs, but it is the role of every healthcare professional to try to address it, especially the pharmacist. Pharmacists can play a key role in educating older adults and their care team about medication-related problems such as drug interactions and potential side effects.

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References

  1. Loya AM, González-Stuart A, Rivera JO. Prevalence of polypharmacy, polyherbacy, nutritional supplement use and potential product interactions among older adults living on the United States-Mexico border. Drugs Aging. 2009;26:423–36.

    Article  PubMed  Google Scholar 

  2. Kim J, Parish AL. Polypharmacy and medication management in older adults. Nurs Clin. 2017;52:457–68.

    Article  Google Scholar 

  3. Muscedere J, Kim P, Aitken P, Gaucher M, Osborn R, Farrell B, Holroyd-Leduc J, Mallery L, Siu H, Downar J. Proceedings of the Canadian frailty network summit: medication optimization for frail older Canadians, Toronto, Monday April 24, 2017. Can Geriatr J. 2017;20:253.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M. Incidence and preventability of adverse drug events among older persons in the ambulatory setting. JAMA. 2003;289:1107–16.

    Article  PubMed  Google Scholar 

  5. Kantor ED, Rehm CD, Haas JS, Chan AT, Giovannucci EL. Trends in prescription drug use among adults in the United States from 1999–2012. JAMA. 2015;314:1818–30.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Fick DM, Cooper JW, Wade WE, Waller JL, Maclean JR, Beers MH. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med. 2003;163:2716–24.

    Article  PubMed  Google Scholar 

  7. Abe T, Tamiya N, Kitahara T, Hasegawa Y, Tokuda Y. Polypharmacy as a risk factor for hospital admission among elderly using emergency transport. BMC Health Serv Res. 2014;14:P2.

    Article  PubMed Central  Google Scholar 

  8. Finkelstein J, Friedman C, Hripcsak G, Cabrera M. Potential utility of precision medicine for older adults with polypharmacy: a case series study. Pharmgenomics Pers Med. 2016;9:31.

    PubMed  PubMed Central  Google Scholar 

  9. Aparasu RR, Mort JR, Brandt H. Polypharmacy trends in office visits by the elderly in the United States, 1990 and 2000. Res Soc Adm Pharm. 2005;1:446–59.

    Article  Google Scholar 

  10. Woo TM, Robinson MV. Pharmacotherapeutics for advanced practice nurse prescribers. Philadelphia: F.A. Davis Company; 2015.

    Google Scholar 

  11. National Council on Aging. Healthy aging facts. 2016. https://www.ncoa.org/news/resources-for-reporters/get-the-facts/healthy-aging-facts/. Accessed 12 Jan 2018.

  12. Yoo JC, Lim TK, Kim DH, Koh K-H. Comparison between the patients with surgery and without surgery after recommendation of surgical repair for symptomatic rotator cuff tear. J Orthop Sci. 2018;23:64–9.

    Article  PubMed  Google Scholar 

  13. Darrow JJ. Explaining the absence of surgical procedure regulation. Cornell J Law Public Policy. 2017;27:189–206.

    PubMed  Google Scholar 

  14. Ferrailo DM, Veitz-Keenan A. No clinical quantifiable benefits between non-surgical and surgical endodontic treatment. Evid Based Dent. 2017;18:75.

    Article  PubMed  Google Scholar 

  15. Benetos A, Rossignol P, Cherubini A, Joly L, Grodzicki T, Rajkumar C, Strandberg TE, Petrovic M. Polypharmacy in the aging patient: management of hypertension in octogenarians. JAMA. 2015;314:170–80.

    Article  CAS  PubMed  Google Scholar 

  16. Abe T, Tamiya N, Kitahara T, Tokuda Y. Polypharmacy as a risk factor for hospital admission among ambulance-transported old-old patients. Acute Med Surg. 2016;3:107–13.

    Article  PubMed  Google Scholar 

  17. Yasu T, Koinuma M, Hayashi D, Horii T, Yashiro Y, Furuya J, Saitoh M, Seki R, Shirota M, Abe K. Association between polypharmacy and clinical ward pharmacy services in hospitals in Tokyo. Geriatr Gerontol Int. 2018;18:187–8.

    Article  PubMed  Google Scholar 

  18. Steinman MA. Polypharmacy—time to get beyond numbers. JAMA Intern Med. 2016;176:482–3.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lyons BP, Dunson-Strane T, Sherman FT. The joys of caring for older adults: training practitioners to empower older adults. J Community Health. 2014;39:464–70.

    Article  PubMed  Google Scholar 

  20. Stefanacci RG, Khan T. Can managed care manage polypharmacy? Clin Geriatr Med. 2017;33:241–55.

    Article  PubMed  Google Scholar 

  21. Montamat SC, Cusack B. Overcoming problems with polypharmacy and drug misuse in the elderly. Clin Geriatr Med. 1992;8:143–58.

    Article  CAS  PubMed  Google Scholar 

  22. Gnjidic D, Hilmer SN, Blyth FM, Naganathan V, Waite L, Seibel MJ, McLachlan AJ, Cumming RG, Handelsman DJ, Le Couteur DG. Polypharmacy cutoff and outcomes: five or more medicines were used to identify community-dwelling older men at risk of different adverse outcomes. J Clin Epidemiol. 2012;65:989–95.

    Article  PubMed  Google Scholar 

  23. Brandt NJ. Optimizing medication use through deprescribing: tactics for this approach. J Gerontol Nurs. 2016;42:10–4.

    PubMed  Google Scholar 

  24. Scott IA, Hilmer SN, Reeve E, Potter K, Le Couteur D, Rigby D, Gnjidic D, Del Mar CB, Roughead EE, Page A. Reducing inappropriate polypharmacy: the process of deprescribing. JAMA Intern Med. 2015;175:827–34.

    Article  PubMed  Google Scholar 

  25. Graham J. End-of-life medications draw more attention, greater scrutiny. JAMA. 2015;313:231–3.

    Article  PubMed  Google Scholar 

  26. Hovstadius B, Petersson G. Factors leading to excessive polypharmacy. Clin Geriatr Med. 2012;28:159–72.

    Article  PubMed  Google Scholar 

  27. Ponte ML, Wachs L, Wachs A, Serra HA. Prescribing cascade: a proposed new way to evaluate it. Med (B Aires). 2017;77:13–6.

    Google Scholar 

  28. Bailey TA, Fenney M. Perceptions of direct-to-consumer advertising and the older adult population. Consult Pharm J Am Soc Consult Pharm. 2016;31:215–20.

    Article  Google Scholar 

  29. Mintzes B, Barer ML, Kravitz RL, Bassett K, Lexchin J, Kazanjian A, Evans RG, Pan R, Marion SA. How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. Can Med Assoc J. 2003;169:405–12.

    Google Scholar 

  30. Datti B, Carter MW. The effect of direct-to-consumer advertising on prescription drug use by older adults. Drugs Aging. 2006;23:71–81.

    Article  PubMed  Google Scholar 

  31. Rochon PA, Gurwitz JH. Optimising drug treatment for elderly people: the prescribing cascade. BMJ. 1997;315:1096–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Gill SS, Mamdani M, Naglie G, Streiner DL, Bronskill SE, Kopp A, Shulman KI, Lee PE, Rochon PA. A prescribing cascade involving cholinesterase inhibitors and anticholinergic drugs. Arch Intern Med. 2005;165:808–13.

    Article  PubMed  Google Scholar 

  33. Rasu R, Agbor-Bawa W, Rianon N. Impact of polypharmacy on seniors’ self-perceived health status. South Med J. 2017;110:540–5.

    Article  PubMed  Google Scholar 

  34. Veronese N, Stubbs B, Noale M, Solmi M, Pilotto A, Vaona A, Demurtas J, Mueller C, Huntley J, Crepaldi G. Polypharmacy is associated with higher frailty risk in older people: an 8-year longitudinal cohort study. J Am Med Dir Assoc. 2017;18:624–8.

    Article  PubMed  PubMed Central  Google Scholar 

  35. George C, Verghese J. Polypharmacy and gait performance in community–dwelling older adults. J Am Geriatr Soc. 2017;65:2082–7.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Kvarnström K, Airaksinen M, Liira H. Barriers and facilitators to medication adherence: a qualitative study with general practitioners. BMJ Open. 2018;8:e015332.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Abe J, Umetsu R, Uranishi H, Suzuki H, Nishibata Y, Kato Y, Ueda N, Sasaoka S, Hatahira H, Motooka Y. Analysis of polypharmacy effects in older patients using Japanese Adverse Drug Event Report database. PLoS One. 2017;12:e0190102.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  38. Harrison SL, O’Donnell LK, Bradley CE, Milte R, Dyer SM, Gnanamanickam ES, Liu E, Hilmer SN, Crotty M. Associations between the drug burden index, potentially inappropriate medications and quality of life in residential aged care. Drugs & Aging. 2018;35(1):83–91.

    Google Scholar 

  39. Ziere G, Dieleman JP, Hofman A, Pols HAP, Van Der Cammen TJM, Stricker BH. Polypharmacy and falls in the middle age and elderly population. Br J Clin Pharmacol. 2006;61:218–23.

    Article  CAS  PubMed  Google Scholar 

  40. von Lueder TG, Atar D. Comorbidities and polypharmacy. Heart Fail Clin. 2014;10:367–72.

    Article  Google Scholar 

  41. Montiel-Luque A, Núñez-Montenegro AJ, Martín-Aurioles E, Canca-Sánchez JC, Toro-Toro MC, González-Correa JA, Polipresact Research Group. Medication-related factors associated with health-related quality of life in patients older than 65 years with polypharmacy. PLoS One. 2017;12:e0171320.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  42. Strehblow C, Smeikal M, Fasching P. Polypharmacy and excessive polypharmacy in octogenarians and older acutely hospitalized patients polypharmazie und exzessive Polypharmazie bei akut hospitalisierten hochbetagten Patienten. Wien Klin Wochenschr. 2014;126:195–200.

    Article  CAS  PubMed  Google Scholar 

  43. Social Care Institute of Excellence. Research briefing 15: helping older people to take prescribed meditation in their home: what works? 2005. Published August 2005. Available from: https://www.scie.org.uk/publications/briefings/briefing15/.

  44. Zaprutko T, Kopciuch D, Kus K, Merks P, Nowicka M, Augustyniak I, Nowakowska E. Affordability of medicines in the European Union. PLoS One. 2017;12:e0172753.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  45. Brieger DB, Chow C, Gullick J, Hyun K, D’souza M, Briffa T, Concordance Investigators. Improving patient adherence to secondary prevention medications 6 months after an acute coronary syndrome: observational cohort study. Intern Med J. 2018;48:541–9.

    Article  PubMed  Google Scholar 

  46. Lee C, Lee K, Yu H, et al. Adverse events with sustained-release donepezil in Alzheimer disease. J Clin Psychopharmacol. 2017;37:401–4.

    Article  CAS  PubMed  Google Scholar 

  47. Hennein R, Hwang S, Au R, Levy D, Muntner P, Fox CS, Ma J. Barriers to medication adherence and links to cardiovascular disease risk factor control: the Framingham Heart Study. Intern Med J. 2018;48:414–21.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Tulner LR, Frankfort SV, Gijsen GJPT, van Campen JPCM, Koks CHW, Beijnen JH. Drug-drug interactions in a geriatric outpatient cohort. Drugs Aging. 2008;25:343–55.

    Article  PubMed  Google Scholar 

  49. Cabré M, Elias L, Garcia M, Palomera E, Serra-Prat M. Avoidable hospitalizations due to adverse drug reactions in an acute geriatric unit. Analysis of 3,292 patients. Med Clin (Barc). 2018;150:209–14.

    Article  Google Scholar 

  50. Masoodi NA. Polypharmacy: to err is human, to correct divine. Br J Med Pract. 2008;1:6–9.

    Google Scholar 

  51. Akazawa M, Imai H, Igarashi A, Tsutani K. Potentially inappropriate medication use in elderly Japanese patients. Am J Geriatr Pharmacother. 2010;8:146–60.

    Article  PubMed  Google Scholar 

  52. Isidoro-García M, Sánchez-Martín A, García-Berrocal B, Román-Curto C. Primun non nocere, polypharmacy and pharmacogenetics. Pharmacogenomics. 2015;16:1903–5.

    Article  PubMed  CAS  Google Scholar 

  53. National Patient Safety Goals. 2005. http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/05_npsgs.htm. Accessed 12 Jan 2018.

  54. Lee JK, Slack MK, Martin J, Ehrman C, Chisholm-Burns M. Geriatric patient care by US pharmacists in healthcare teams: systematic review and meta-analyses. J Am Geriatr Soc. 2013;61:1119–27.

    Article  PubMed  Google Scholar 

  55. Nkansah N, Mostovetsky O, Yu C, Chheng T, Beney J, Bond CM, Bero L. Effect of outpatient pharmacists’ non-dispensing roles on patient outcomes and prescribing patterns. Cochrane Database Syst Rev. 2010;(7):CD000336.

    Google Scholar 

  56. Hanlon JT, Schmader KE, Samsa GP, Weinberger M, Uttech KM, Lewis IK, Cohen HJ, Feussner JR. A method for assessing drug therapy appropriateness. J Clin Epidemiol. 1992;45:1045–51.

    Article  CAS  PubMed  Google Scholar 

  57. Elwyn G, Dehlendorf C, Epstein RM, Marrin K, White J, Frosch DL. Shared decision making and motivational interviewing: achieving patient-centered care across the spectrum of health care problems. Ann Fam Med. 2014;12:270–5.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Lipska KJ, Krumholz H, Soones T, Lee SJ. Polypharmacy in the aging patient: a review of glycemic control in older adults with type 2 diabetes. JAMA. 2016;315:1034–45.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Nikolaus T, Kruse W, Bach M, Specht-Leible N, Oster P, Schlierf G. Elderly patients’ problems with medication. Eur J Clin Pharmacol. 1996;49:255–9.

    Article  CAS  PubMed  Google Scholar 

  60. Barat I, Andreasen F, Damsgaard EMS. Drug therapy in the elderly: what doctors believe and patients actually do. Br J Clin Pharmacol. 2001;51:615–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Spiers MV, Kutzik DM, Lamar M. Variation in medication understanding among the elderly. Am J Health Syst Pharm. 2004;61:373–9.

    Article  PubMed  Google Scholar 

  62. Fineman B, DeFelice C. A study of medication compliance. Home Healthc Nurse. 1992;10:26–9.

    Article  CAS  PubMed  Google Scholar 

  63. Blenkiron P. The elderly and their medication: understanding and compliance in a family practice. Postgrad Med J. 1996;72:671–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Cline CMJ, Björck-Linné AK, Israelsson BYA, Willenheimer RB, Erhardt LR. Non-compliance and knowledge of prescribed medication in elderly patients with heart failure. Eur J Heart Fail. 1999;1:145–9.

    Article  CAS  PubMed  Google Scholar 

  65. Lourens H, Woodward MC. Impact of a medication card on compliance in older people. Australas J Ageing. 1994;13:72–6.

    Article  Google Scholar 

  66. Coleman EA, Smith JD, Frank JC, Min S, Parry C, Kramer AM. Preparing patients and caregivers to participate in care delivered across settings: the Care Transitions Intervention. J Am Geriatr Soc. 2004;52:1817–25.

    Article  PubMed  Google Scholar 

  67. Raynor DK, Booth TG, Blenkinsopp A. Effects of computer generated reminder charts on patients’ compliance with drug regimens. BMJ. 1993;306:1158–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Goodyer LI, Miskelly F, Milligan P. Does encouraging good compliance improve patients’ clinical condition in heart failure? Br J Clin Pract. 1995;49:173–6.

    CAS  PubMed  Google Scholar 

  69. World Health Organization. Framework for action on interprofessional education and collaborative practice. Geneva: WHO; 2010.

    Google Scholar 

  70. Patel R, Zhu L, Sohal D, Lenkova E, Koshki N, Woelfel J, Ranson C, Valle-Oseguera CS, Rogan EL. Use of 2015 Beers criteria medications by older medicare beneficiaries. Consult Pharm. 2018;33:48–54.

    Article  PubMed  Google Scholar 

  71. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014;13:57–65.

    Article  PubMed  Google Scholar 

  72. Kiel WJ, Phillips SW. Impact of pharmacist-conducted comprehensive medication reviews for older adult patients to reduce medication related problems. Pharmacy. 2017;6:2.

    Article  PubMed Central  Google Scholar 

  73. Tannenbaum C, Martin P, Tamblyn R, Benedetti A, Ahmed S. Reduction of inappropriate benzodiazepine prescriptions among older adults through direct patient education: the EMPOWER cluster randomized trial. JAMA Intern Med. 2014;174:890–8.

    Article  PubMed  CAS  Google Scholar 

  74. Niehoff KM, Rajeevan N, Charpentier PA, Miller PL, Goldstein MK, Fried TR. Development of the tool to reduce inappropriate medications (TRIM): a clinical decision support system to improve medication prescribing for older adults. Pharmacother J Hum Pharmacol Drug Ther. 2016;36:694–701.

    Article  Google Scholar 

  75. Garfinkel D. Poly-de-prescribing to treat polypharmacy: efficacy and safety. Ther Adv Drug Saf. 2018;9:25–4. 32042098617736192.

    Article  PubMed  Google Scholar 

  76. Zhou S-F, Ming Di Y, Chan E, Du Y-M, Chow VD-W, Xue CC, Lai X, Wang J-C, Li CG, Tian M. Clinical pharmacogenetics and potential application in personalized medicine. Curr Drug Metab. 2008;9:738–84.

    Article  CAS  PubMed  Google Scholar 

  77. Gelissen IC, McLachlan AJ. The pharmacogenomics of statins. Pharmacol Res. 2014;88:99–106.

    Article  CAS  PubMed  Google Scholar 

  78. Rusnak JM, Kisabeth RM, Herbert DP, McNeil DM. Pharmacogenomics: a clinician’s primer on emerging technologies for improved patient care. Mayo Clin Proc: Elsevier. 2001;76:299–309.

    Article  CAS  Google Scholar 

  79. Brooks M. Genetic test identifies best antidepressant. Medscape Medical News. 2018.

    Google Scholar 

  80. Hanlon JT, Semla TP, Schmader KE. Medication misadventures in older adults: literature from 2013. J Am Geriatr Soc. 2014;62:1950–3.

    Article  PubMed  PubMed Central  Google Scholar 

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Authors and Affiliations

  1. Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Department of Pharmacy Practice and Science, Baltimore, MD, USA

    Daniel Z. Mansour & Nicole J. Brandt

  2. Peter Lamy Center on Drug Therapy and Aging, University of Maryland School of Pharmacy, Department of Pharmaceutical Health Services Research, Baltimore, MD, USA

    Kriti Sharma

  3. MedStar Good Samaritan Hospital, Center for Successful Aging, Baltimore, MD, USA

    Nicole J. Brandt

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  1. Daniel Z. Mansour
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Correspondence to Daniel Z. Mansour .

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  1. Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Audrey Chun

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Mansour, D.Z., Sharma, K., Brandt, N.J. (2020). Understanding the Medication List and Addressing Polypharmacy in Older Adults. In: Chun, A. (eds) Geriatric Practice. Springer, Cham. https://doi.org/10.1007/978-3-030-19625-7_16

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