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Medications of Older Adults (Polypharmacy & Ethical Principles) Denise Angela D. Jumawan Kyle Nicole Untalan Lesson Outline 01 Introduction to Medications in Older Adults 02 Polypharmacy in Older Adults 03 Ethical Principles in Managing Medications 04 Medicat...

Medications of Older Adults (Polypharmacy & Ethical Principles) Denise Angela D. Jumawan Kyle Nicole Untalan Lesson Outline 01 Introduction to Medications in Older Adults 02 Polypharmacy in Older Adults 03 Ethical Principles in Managing Medications 04 Medication Safety in Older Adults INTRODUCTION TO MEDICATIONS IN OLDER ADULTS Overview of Common Medications Prescribed to Older Adults Antihypertensives – Manage high blood pressure (e.g., ACE inhibitors, beta- blockers). Diuretics – Treat fluid retention and heart conditions (e.g., Furosemide, Thiazides). Analgesics – Relieve pain (e.g., NSAIDs, opioids, acetaminophen). Anticoagulants – Prevent blood clots (e.g., Warfarin, Direct oral anticoagulants). Cognitive Enhancers – For dementia (e.g., Donepezil, Memantine). Antidepressants – Address mental health issues (e.g., SSRIs, SNRIs, TCAs). Hypoglycemics – Control blood sugar in diabetes (e.g., Metformin, insulin). Lipid-lowering Agents – Manage cholesterol (e.g., Statins). Antibiotics – Treat infections (e.g., Penicillins, Cephalosporins). Bronchodilators – For respiratory conditions like COPD (e.g., Albuterol, Ipratropium). Challenges Specific to Pharmacotherapy in Aging Populations Polypharmacy – increased risk of adverse drug interactions due to multiple medications Altered Pharmacokinetics and Pharmacodynamics – Age-related changes in drug absorption, distribution, metabolism, and excretion; reduced liver and kidney function affects how drugs are processed. Adherence Issues Cognitive decline (e.g., dementia, memory loss) affects the ability to follow complex medication regimens. Vision and hearing impairments make it difficult to understand instructions. Physical limitations (e.g., arthritis) can make handling medication (e.g., opening bottles) challenging. Increased Sensitivity Higher risk of adverse reactions due to physiological changes. Greater vulnerability to side effects like dizziness, confusion, and falls. Challenges Specific to Pharmacotherapy in Aging Populations Drug-Disease Interactions – Certain medications can worsen pre-existing conditions (e.g., NSAIDs aggravating heart failure). Ethical Considerations Balancing treatment intensity with quality of life and comfort. Informed consent challenges, especially in cases of cognitive impairment. Potential over-treatment or under-treatment based on age bias. Cost and Access Issues Many older adults face financial barriers to accessing medications. Insurance limitations and coverage gaps can influence treatment choices. POLYPHARMACY IN OLDER ADULTS  Polypharmacy in Older Adults Polypharmacy Defined as the regular use of 5 or more medications at the same time. This condition is particularly prevalent among older adults, who often manage several chronic health issues requiring multiple prescriptions. According to a report from the U.S. Centers for Disease Control and Prevention, about a third of American adults in their 60s and 70s use five or more prescription drugs regularly. This trend reflects a significant increase in medication use among older adults, largely due to the rising prevalence of chronic conditions. As the population ages, the reliance on multiple medications—often referred to as polypharmacy—raises concerns about potential drug interactions and the overall management of health care for this demographic. Causes of polypharmacy 1. Chronic Diseases – Older adults often have long-term health conditions like high blood pressure, diabetes, or arthritis. Each of these conditions may require its own medication. As a result, an older adult may end up taking several different medications at once to manage these issues. 2. Multiple Healthcare Providers – Older adults often see different doctors for different health concerns. For example, they might have a heart specialist, a diabetes doctor, and a general physician. Sometimes, these doctors don't always communicate with each other, which can lead to multiple prescriptions for similar issues, causing medication overlap. 3. Hospitalizations – When older adults are hospitalized, doctors may add new medications to treat conditions that develop during the hospital stay. However, the doctors might not review or stop some of the medications the person was already taking, leading to an increase in the total number of medications. 4. Self-medication – Many older adults use over-the-counter medications, vitamins, or supplements to treat symptoms on their own. They might not always inform their doctors about these, which can lead to an unintentional mix of medications that could interact with their prescriptions. 5. Lack of Medication Review – Medications should be reviewed regularly to check if they are still needed. If an older adult’s medications aren't reassessed often, they may continue to take drugs that are no longer necessary or have multiple prescriptions for the same condition. This can result in taking too many medications without realizing it. Risks associated with polypharmacy Adverse Drug Reactions (ADRs): Older adults are particularly vulnerable to adverse drug reactions due to age-related physiological changes, such as decreased liver and kidney function, which affect drug metabolism and elimination. Medication Errors: occur when there is a mistake in prescribing, dispensing, or taking medications. This can include giving the wrong dosage or failing to account for a patient's allergies. Drug Interactions: When two or more medications react adversely with each other. Older adults often take multiple prescriptions, increasing the risk of interactions. Duplication of Drug Therapy: This occurs when a patient is prescribed multiple medications that serve the same purpose. Medication Non-Adherence: Medication non-adherence refers to patients not taking their medications as prescribed. Financial Burden: Polypharmacy can create a significant financial burden for older adults, as managing multiple prescriptions often leads to high out-of-pocket expenses. This can result in medication non-adherence when patients skip doses or discontinue medications because they cannot afford them, potentially worsening their health outcomes. Decreased Quality of Life: Managing multiple medications often leads to stress, confusion, and frustration, as they may struggle to keep track of dosing schedules. This can result in feelings of helplessness and anxiety, ultimately reducing their overall well-being. Strategies to Reduce Polypharmacy Medication Review: Regularly assess all medications a patient is taking to determine their necessity, effectiveness, and safety. This helps identify medications that may no longer be needed or could be harmful. Deprescribing: Systematically discontinuing medications that are no longer beneficial or may cause harm. It involves safely reducing or stopping medicines that are no longer necessary. Non-pharmacological Interventions: Consider alternative therapies such as lifestyle modifications, physical therapy, or counseling to manage conditions without the need for additional medications. Patient and Caregiver Education: Educating patients and caregivers about the risks of polypharmacy and encouraging them to discuss medication concerns with their healthcare providers. Interdisciplinary Collaboration: Ensuring communication between healthcare providers (physicians, pharmacists, and nurses) to coordinate the patient’s treatment and prevent overlapping prescriptions. ETHICAL PRINCIPLES IN MANAGING MEDICATIONS  Ethical Principles in Managing Medications Overview of Ethical Principles 1.Autonomy - Respecting patients’ rights to make informed decision about their own care. 2.Beneficence - Acting in the best interest of the patient to promote their well-being. 3.Non-maleficence - Commitment to do no harm; ensuring that interventions do not worsen he patient’s condition. 4.Justice - Ensuring fairness in the distribution of healthcare resources and treatment.  The Role of Informed Consent in Medication Management Importance of clear communication about medication risks and management. Ensuring patients understand their treatment options and can participate in decision-making.  Ethical Considerations in Poly pharmacy and De-prescribing Polypharmacy — Navigating the complexities of managing multiple medications, potential for adverse effects, and the need for regular medications reviews. De-prescribing — The ethical imperative to reassess and discontinue unnecessary medications to reduce the risk of harm and enhance quality of life. MEDICATION SAFETY IN OLDER ADULTS  Common medication errors in older adults A medication error has been defined as any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health-care professional, patient, or consumer. Medication errors made by patients can be classified into: Commission errors (for example: error in calculating the dose, repetition of the dose, doubts about how to use the dispensers correctly, taking the medication from another person or a pet, taking it once expired, storing it in inappropriate conditions, etc.). Errors of omission derived from not having the correct information, confusing instructions, and forgetting the doctor´s or pharmacist´s instructions. These errors, in some cases, can lead to severe damage that requires a new pharmacological treatment, hospitalization or can have fatal consequences. Common medication errors among older adults include: 1. Incorrect Dosage - Taking either too much or too little of a prescribed medication. This may occur due to difficulty reading labels, confusion about the dosing schedule, or simply forgetting to take the medication. 2. Polypharmacy Issues - Many older adults take multiple medications, increasing the risk of drug interactions or accidental overdose. Confusion about which medications to take and when can also lead to errors. 3. Failure to Follow Instructions - Older adults may not fully understand how to take their medications correctly. For example, they might fail to take drugs with food or avoid certain activities that could interfere with the medication’s effectiveness. 4. Drug Duplication - Taking multiple medications that contain the same active ingredient can lead to accidental overdosing. This is especially common with over-the-counter medications and prescription drugs. 5. Adverse Drug Reactions - Older adults are more susceptible to adverse drug reactions due to slower drug metabolism and elimination from the body, increasing the risk of negative side effects. 6. Miscommunication with Healthcare Providers - Misunderstanding or forgetting medication instructions provided by healthcare professionals can lead to errors in medication management. 7. Wrong Timing - Taking medications at the wrong time of day or failing to adhere to specific schedules can reduce the effectiveness of the treatment or cause adverse effects. Role of Healthcare Professionals in Ensuring Safe Medication Use: Prescribers (Physicians, Nurse Practitioners): Responsible for evaluating the patient's condition and prescribing medications that are appropriate, effective, and safe for the patient’s medical history and current condition. They ensure proper dosing, monitor for side effects, and adjust treatment as necessary. Pharmacists: Play a key role in reviewing prescriptions, checking for drug interactions, educating patients about how to take medications correctly, and ensuring that the patient understands the purpose of each medication. They also help with medication management through services like medication therapy management (MTM). Nurses: Administer medications in healthcare settings, educate patients about their medications, monitor for adverse reactions, and act as a liaison between the patient and the prescribing healthcare provider to ensure safety. All healthcare professionals must work together, sharing patient information and coordinating care to prevent medication errors and promote safe medication use. Patient Education and Empowerment in Managing Medications: Understanding Medication Purpose: Patients should be educated about why they are taking each medication, including its expected benefits and any potential risks or side effects. Proper Medication Administration: Patients need to know how to take their medications correctly (e.g., time of day, with or without food) and be aware of any restrictions (e.g., alcohol or certain foods). Recognizing Side Effects: Empowering patients to recognize and report adverse effects early can prevent complications and allow for timely adjustments to therapy. Medication Adherence: Educating patients on the importance of taking their medications as prescribed, even if they feel well, to ensure long-term health benefits. Encouraging Questions: Patients should be encouraged to ask questions and actively participate in decisions about their medication regimen, helping them feel more in control and making it easier for them to manage their medications effectively. Thank You!