Preventing Polypharmacy in Older Adults

Kathleen Woodruff MS, CRNP

Disclosures

Am Nurs Journal. 2010;5(10) 

In This Article

Nurse's Role

As a nurse, you can be pivotal in helping older patients manage their medications and prevent polypharmacy. The keys to reducing polypharmacy risks are information, instruction, and organization (summarized in the table below.)

Reducing medication risks in older adults
Here are strategies you can use to help patients reduce the risk of polypharmacy.
Information. Discuss with patients the need to:
  • keep an accurate list of all medications, including generic and brand names, dosages, dosing frequency, and reason for taking the drug

  • keep a complete list of medical providers and their contact information

  • post the name and telephone number of the local pharmacy.

Instruction. Teach patients about:
  • each medication, including its name, appearance, purpose, and effects

  • potential adverse effects and interactions of each medication

  • importance of contacting the healthcare provider with concerns or questions

  • potential drug-related problems that warrant emergency care

  • importance of taking medications exactly as directed

  • importance of using only one pharmacy to obtain drugs.

Organization. To help patients manage their drugs, caution them to:
  • avoid sharing medications

  • store medications in a secure, dry location away from sunlight

  • refrigerate medications if necessary

  • dispose of old medications properly.

Also, if appropriate, help patients establish memory aids. For instance, advise patients to link drug administration to their daily routine or to use color-coded charts, automatic dispensers with bells, or voice-activated message services to remember to take their doses.

Information includes discussing with patients the need to keep an accurate list of all medications (both prescription and OTC) they're currently taking. Advise them to record the medication names (generic and brand), prescribed dosage and dosing frequency, and the reason it was prescribed. The sample template below can be useful for older patients.

Teach patients to take all medications to their medical appointments to verify they're taking the right drugs. Often called a "brown bag" check, this is a good way to eliminate confusion over previously discontinued drugs or incorrect dosages. Inform patients of any dietary restrictions necessitated by a specific medication. During healthcare appointments, teach the patient about potential side effects, including when to call the clinic or go to the emergency room. This also gives you an opportunity to clear up any confusion caused by look-alike or sound-alike drug names or drugs with similar appearances. These face-to-face meetings are invaluable; as you establish a strong relationship with the patient, you can find out how the patient is actually taking the medications.

Instruction must be combined with good communication. Optimally, patient care should be directed by a limited number of healthcare providers. The primary-care provider and specialists must maintain good communication with each other to prevent or minimize problems. Advise patients to use only one pharmacy to obtain medications; this adds another level of review to help ensure appropriate dosage and reduce the risk of adverse drugs effects and interactions. Instruct patients to take medications as instructed and to inform their providers if health changes occur, especially after starting a new medication. Caution them not to stop taking a drug without consulting their healthcare provider. At each visit, ask patients about their adherence to the medication regimen and their use of OTC preparations.

Organization can improve adherence. Complex medication regimens are challenging even for the most diligent patients. Caution patients to take only those drugs prescribed for them and not to share medications with others or save them for future use. Teach them to store medications in a secure, dry location away from direct sunlight or to refrigerate them if needed. As appropriate, recommend use of 7-day pill boxes, daily pill boxes, or blister packs to help patients adhere to their regimen. Color-coded charts can help elderly patients set up pill boxes. For patients with cognitive deficits, recommend the use of drug dispensers with bells, automatic dispensers with voice-activated messages, and regular or video-telephone call reminders, as appropriate. Another basic technique to improve adherence is to link dosing schedules to routine activities of daily living, such as brushing the teeth, eating breakfast, or other activities that can serve as memory triggers.

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