Polypharmacy and potentially inappropriate medications for elder people in gerontological nursing

Abstract

Objective: To identify polypharmacy and potentially inappropriate medications (PIM) for elder people with chronic health situations and its implications for gerontological nursing. Method: Descriptive and transversal study, conducted from March to September 2016 by pharmaceutical residents in the clinic of Endocrinology of a hospital in Mid-West region of Brazil. Results: 44 elder people with an average age of 69.5 (± 6.79) years old had their assessed prescriptions. We identified 65 medications prescribed 253 times, in which 10 PIM (15.4%) were prescribed 51 times. 33 seniors (72.7%) had at least one PIM, of those, 66.7% were polymedicated. Of the total, 22 elder people (50%) were subjected to polypharmacy and made use of at least one PIM. Conclusion: The results showed high incidence of PIM and polypharmacy, as well as their physiological impacts to the elder population. The study provokes discussions about that the trained nurse in human aging has skills and competencies able to enhance interventions related to pharmacotherapy.

Factors associated with the use of potentially inappropriate medications by elderly people with hypertension

“…The difficulties of health professionals in monitoring the elderly with hypertension, such as care focused on the disease, academic training based on the biomedical model, lack of intersectionality and care discontinuity in the care network are evident in evaluative studies of primary care (4,13,31,33) . Thus, we warn about the organization of teams working in the FHS, predictive of the offer improvement and demand monitoring of elderly people in the treatment of hypertension, by training on the process and management of health actions for this part of the population, which makes use of PIM for their age group (2,(4)(5) .…”

“…Given the complexity of the elderly care with hypertension, medication therapy needs to be constantly monitored by health professionals at the primary level (2) . Some medications are inappropriate for the population over 60 years old due to the adverse effects inherent to their mechanism of action, which offer more risks than benefits, with triggering of symptoms related to bradycardia, toxicity, when in prolonged use, or risk of falls (5) .…”

“…In the context of Primary Health Care (PHC), the use of more than one medication among the elderly is high, which classifies them as polypharmacy. Polypharmacy and the accentuated use of PIM can cause the iatrogenic cascade, in which there is a need for health professionals to know the selection, prescription and dispensing of medications, especially in elderly people with hypertension, to avoid complications inherent to chronic morbidity, enhanced by the use of these medications (5,(7)(8) .…”

Oral Administration of Poly-pharmacy in Institutionalized Elderly Patients with Dysphagia

“…The potential of food-drug interaction was seen in the prescriptions of elderly patients related to Alzheimer's. The prevalence of poly-pharmacy and food-drug interaction is extremely high in the nursing care, due to crush pills or open capsules so that patients presenting problems swallowing and/or behavior issues may take the medicines more easily [2,8]. These practices, marked by frequent errors, increased drug interaction risks as well as adverse effects and even could lead to toxic effects for both patients and caregivers [9].…”

Adverse drug reactions related to potential serious drug interactions in patients with cardiovascular diseases

“…Unwanted drug interactions are a reality in the clinical practice and their occurrence can favor: ineffective therapy, increased length of stay and cost of hospitalization, and even serious events that compromise the patient's life. The main risk factor for the interaction is polypharmacy, that is, the concomitant use of five or more drugs (2)(3)(4) .…”