TY - JOUR
T1 - Polypharmacy Management in Older Patients
AU - Hoel, Robert William
AU - Giddings Connolly, Ryan M.
AU - Takahashi, Paul Y.
N1 - Publisher Copyright:
© 2020 Mayo Foundation for Medical Education and Research
PY - 2021/1
Y1 - 2021/1
N2 - Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed “polypharmacy.” This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems. To reduce polypharmacy, we delineate a systematic, consultative approach to identify highest-risk medications and drug-therapy problems. We address strategic reductions (deprescribing) of medications in palliative care, long-term care, and ambulatory older adults. Best practices for reducing opioids, benzodiazepines, and other high-risk medications include education about risk and agreement by patients and their families, advocates, and care teams. Addressing deprescribing should be within the framework of patients' health status as their care and goals transition from longevity to a plan of maintaining alertness, comfort, and satisfaction of quality of life. A team approach to address polypharmacy and avoidance of high-risk therapy is optimal within long-term care. Patients with terminal illnesses or those moving toward a comfort-care emphasis benefit from medication adjustments that are recognized beneficially within each patient's care goals. In caring for older adults, the acknowledgement that complicated regimens and high-risk medications requires a care plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.
AB - Medications to treat disease and extend life in our patients often amass in quantities, resulting in what has been termed “polypharmacy.” This imprecise label usually describes the accumulation of 5, and often more, medications. Polypharmacy in advancing age frequently results in drug therapy problems related to interactions, drug toxicity, falls with injury, delirium, and nonadherence. Polypharmacy is associated with resulting increased hospitalizations and higher costs of care for individuals and health care systems. To reduce polypharmacy, we delineate a systematic, consultative approach to identify highest-risk medications and drug-therapy problems. We address strategic reductions (deprescribing) of medications in palliative care, long-term care, and ambulatory older adults. Best practices for reducing opioids, benzodiazepines, and other high-risk medications include education about risk and agreement by patients and their families, advocates, and care teams. Addressing deprescribing should be within the framework of patients' health status as their care and goals transition from longevity to a plan of maintaining alertness, comfort, and satisfaction of quality of life. A team approach to address polypharmacy and avoidance of high-risk therapy is optimal within long-term care. Patients with terminal illnesses or those moving toward a comfort-care emphasis benefit from medication adjustments that are recognized beneficially within each patient's care goals. In caring for older adults, the acknowledgement that complicated regimens and high-risk medications requires a care plan to reduce or prevent medication-related problems and costs that are associated with polypharmacy.
UR - http://www.scopus.com/inward/record.url?scp=85099228045&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85099228045&partnerID=8YFLogxK
U2 - 10.1016/j.mayocp.2020.06.012
DO - 10.1016/j.mayocp.2020.06.012
M3 - Review article
C2 - 33413822
AN - SCOPUS:85099228045
SN - 0025-6196
VL - 96
SP - 242
EP - 256
JO - Mayo Clinic proceedings
JF - Mayo Clinic proceedings
IS - 1
ER -