At Facilities and at Home Polypharmacy is Causing More Harm Than Good
t is easier to figure out why doctors prescribe so many pills, the hard part is to figure out why they can’t stop doing it. The culture of prescribing medications is embedded in our traditional way of care, the pharmaceutical industry, and doctors who have been trained to find a pill to every and any kind of problem. The phenomenon is called polypharmacy. A cocktail of drugs in which the resulting side effects is larger than the sum of its parts.
Let’s explore the main points worth knowing and than what you can do about it; so read on. The most vulnerable population is the elderly who is helpless, have many physical and mental health complications and don’t have too many advocates.
If you ever worked in a nursing home, or have a relative in one you’ve noticed that the medication pass is the main form of care. For any and every type of problem there is a little pill. Over medication of the elderly is also a problem for those living at home too as older folks struggle to remember what these pills are for, how many they should be taking and if they’ve already taken them.
Some medications are necessary and justified because they produce positive result. But for medications to produce good results there must be a labor intense monitoring; titration, stopping, changing to other meds and ordering a variety of tests. This is the root of the problem because this labor intensive monitoring does not happen at the same ratio as doctors order new meds. The end result is a medication list that is increasingly longer and the developing of many side effects that are perceived as disease processes and thus producing more med orders.
New medications are added on top of existent ones . Med consolidation does not occur often enough for a variety of reasons. LVN’s are so busy passing meds and barely have time to pass all the meds ordered. They are the ones who should be looking at efficacy of these drugs and report to the doctors; that only happens when a crisis situation occurs. Nursing home physicians have so many convalescents to care for, they also don’t have the time to look at it very often. Weeks or months could go by without changes. There is also a strong tendency to add more medication rather then discontinue the ones already prescribed .
Another common problem of polypharmacy is that side effects produced by some drugs may be interpreted as new symptom or a new complication. This is even more problematic for the elderly living at home alone. Large numbers of medication are difficult to manage, and patients may end up easily taking more medication then they need. Elderly with memory deficit can’t keep track of things and may not provide ideal information to physicians or clinics. Without a careful investigation, PCP may prescribe medications without being aware of previous ones.
The main problems with polypharmacy
- Over medicated patients [2 1]
- This is a pervasive problem. Statins, pain meds, antidepressants, anti anxiolitics to name a few, are many times over prescribed. Our industry does not perceived a long and useless list of meds as being a problem. This usually means we are doing something or “taking care”; this is not often the case.
- Redundant medications
- It is not uncommon to find outdated med list with sometimes 2 -3 drugs in the same category. This is very common among elderly living at home and with a history of seen several doctors in different clinics. Med reconciliation happens more often in nursing homes.
- Compounded side effects
- This is at the core concept of polypharmacy. It is not uncommon to find patients with 10 -15 different meds. These are basically drug cocktails. It is very difficult to evaluate what the combined compounds will do when exposed to each other. The results are more side effects and increased risk for dementia, fall, and widespread cognitive and physical decline. 
- Side effect misinterpretation
- Some side effects can be mistaken by new developing conditions. This will most often lead to additional medication prescribed. A drug may be causing liquid retention and it may be perceived as complications of heart failure.
- Risk for fall
- Nursing home residents are at an increased risk for fall when exposed to polypharmacy 
- Risk for dementia
What you can do to help
Nurses are in a unique position to help prevent problems associated with polypharmacy. Nurses are in constant contact with patients and can address it by simply being pro active. Look over medication lists and talk to the doctor. Become an expert in organizing medication list and providing med reconciliation. Be a patient’s advocate. Remember the patient has the right to refuse treatment. You can be a patient liaison.
Know more about the medication you are about to give. The more you know the stronger will be your argument when you advice your doctor. The more you know the more you’ll be respected. This is also a way to become a safer nurse. Remember that you are the one giving these medications and you have the right to ask questions and ask for clarification. Ultimately think that every old person you are about to give meds is either your mother or your father. This will really make a difference on how you think through the whole process.
The desire to take medicine is perhaps
the greatest feature which distinguishes
man from animals.
—Sir William Osler (1849–1919)
Image reference: flickr.com
- Statins and the risk of dementia
- Potentially Inappropriate Medications and Functional Decline in Elderly Hospitalized Patients
- Fall-related injuries in a nursing home setting: is polypharmacy a risk factor?
- Polypharmacy and Potentially Inappropriate Medication Use among Community-Dwelling Elders with Dementia
- Polypharmacy Correlates With Increased Risk for Hip Fracture in the Elderly
- The Effects of Polypharmacy in Older Adults
- Functional Decline Associated with Polypharmacy and Potentially Inappropriate Medications in Community-Dwelling Older Adults with Dementia
- Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan.
- Polypharmacy statistics
- Polypharmacy as a Risk Factor in the Treatment of Type 2 Diabetes
- Impact of Central Nervous System (CNS) Medication Use on Cognition Decline in Community Dwelling Older Adults:
Findings from the Health, Aging and Body Composition Study
- Drug-Drug Interactions Among Elderly Patients Hospitalized for Drug Toxicity
- CDC statistics