SHM's Clinical Quick Talks-Approach to Polypharmacy

Pdf Summary

Polypharmacy, the use of multiple medications by a patient, can have a significant impact on older adults due to age-related changes in their bodies. These changes can affect the absorption, distribution, metabolism, and elimination of drugs. For example, absorption may slow down, distribution may be affected by changes in body water and muscle mass, metabolism may decrease, and elimination may take longer. As a result, medications may have a greater effect on older adults, potentially leading to adverse outcomes such as falls, frailty, prolonged hospital stays, readmissions, and even death.<br /><br />Psychotropic medications, which affect mental function and behavior, are particularly associated with adverse outcomes in polypharmacy. To prevent polypharmacy and the associated prescribing cascade, healthcare providers can conduct thorough medication reviews at regular intervals, optimize prescribing by eliminating inappropriate medications, and avoid unnecessary psychotropic medications. Deprescribing, the process of tapering off or discontinuing medications, can also be beneficial. Various resources and guidelines are available for deprescribing different classes of medications.<br /><br />The Choosing Wisely Campaign offers recommendations for medication use in the elderly, including avoiding antipsychotic medications as a first-line treatment for behaviors associated with dementia and avoiding tight glycemic control in the elderly to reduce the risk of hypoglycemia. They also advise against prescribing certain medications without a thorough review of the patient's medication list.<br /><br />In summary, understanding the effects of aging on pharmacokinetics and pharmacodynamics is important for optimizing safe prescribing and managing polypharmacy in older adults. Regular medication reviews, appropriate prescribing, and deprescribing when necessary can help prevent adverse outcomes associated with polypharmacy. Following evidence-based guidelines, such as those provided by the Choosing Wisely Campaign, can further support safe and appropriate medication use in the elderly.

Asset Subtitle

Himabindu Lanka

Keywords

Polypharmacy

older adults

age-related changes

medications

adverse outcomes

psychotropic medications

deprescribing

Choosing Wisely Campaign

pharmacokinetics

pharmacodynamics