Abstract
There is an urgent need to address the growing problem of polypharmacy in the elderly.
Elderly patients are often prescribed multiple medications, some of which are high
risk or no longer necessary, which increases the risk for adverse drug reactions and
health care costs. Reducing polypharmacy should be a priority for clinicians working
in nursing homes. Clinicians should consider care goals, disease trajectory, and life
expectancy when discontinuing medications. This article discusses the challenges associated
with deprescribing, the ethical and clinical uncertainty that can exist in the indefinite
use of some medications, and the guidelines available to help clinicians.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The Journal for Nurse PractitionersAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Feasibility study of a systematic approach for discontinuation of multiple medications in older adults.Arch Intern Med. 2010; 170: 1648-1654
- Inappropriate prescribing and adverse drug events in older people.BMC Geriatr. 2009; 9: 5
- Deprescribing trials: methods to reduce polypharmacy and the impact on prescribing and clinical outcomes.Clin Geriatr Med. 2012; 28: 237-253
- Managing medications in clinically complex elders: “there's got to be a happy medium.”.JAMA. 2010; 304: 1592-1601
- Deprescribing in the last year of life. 2011.J Pharm Pract Res. 2011; 41: 146-151
- Minimizing inappropriate medications in older populations: a 10 step conceptual framework.Am J Med. 2012; 125: 529-537
- Reconsidering medication appropriateness for patients late life.Arch Intern Med. 2006; 166: 605-609
- Drug-related problems in the frail elderly.Can Fam Physician. 2011; 57: 168-169
- Discontinuing medications: a novel approach for revising the prescribing stage of the medication-use process.J Am Geriatr Soc. 2008; 56: 1946-1952
- Deciding when to stop: towards evidence based deprescribing of drugs in older populations.Evid Based Med. 2013; 18: 121-124
- Deprescribing: achieving better health outcomes for older people through reducing medications.J Pharm Pract Res. 2003; 33: 323-328
- Polypharmacy in the elderly. Increased meds raises the risk of drug interactions and adverse side effects.Adv for Nurses. 2010; : 1-5
- Thinking through the medication list- appropriate prescribing and deprescribing in robust and frail older patients.Aust Fam Physician. 2012; 41: 924-928
- Pharmacotherapy for hypertension in the elderly.Cochrane Database Syst Rev. 2009; : CD000028
- Medication quality of life in the elderly, a cohort study.Health Qual Life Outcomes. 2011; 9: 1-9
Biography
Linda M. Liu, DNP, ANP-BC, GNP-BC, ACHPN, MSc(a), is a geriatric nurse practitioner for UnitedHealthcare Community Plan in Waltham, MA.
Article info
Publication history
Published online: November 01, 2013
Footnotes
In compliance with national ethical guidelines, the author reports no relationships with business or industry that would pose a conflict of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.