Polypharmacy and the older adult
Deborah Robertson provides an overview of recently published articles that may be of interest to non-medical prescribers. Should you wish to look at any of the papers in more detail, a full reference is provided
Last month's research roundup provided you with an overview of articles looking at the role and remit of physiotherapist prescribers (Robertson, 2022). This month, we will be reviewing articles concerning polypharmacy and the older adult. The first article considers polypharmacy in cancer treatment, the second looks at the area of heart failure and the role of the multidisciplinary team. Finally, we will review an article on polypharmacy and type 2 diabetes.
This review of the literature published in the Journal of Geriatric Oncology aimed to elucidate the scale of the issue in a population of older adult patients with cancer and to discuss the implications of this with a specific focus on those undergoing treatment with radiotherapy (Novack et al, 2022).
The authors begin by outlining the issue of polypharmacy and its place in the public health agenda. They acknowledge that this particularly affects the older age group and define it as patients taking five or more medications at the same time, although they do concede that differences in definition do exist within the literature. Polypharmacy is further subcategorised into minor, major and excessive. It is important to note that all of these could still be appropriate and to differentiate between this and inappropriate which is more high risk. The literature review revealed that the prevalence can vary between 10 and 90% but that this varies and grows with increasing age. They discovered that in the population of older adults with cancer, around 50% of patients had polypharmacy and by the end of radiation therapy this increased to 75%. It is because of these figures that this is of such keen interest to researchers at this time. There were many areas of interest that stemmed from the review and the authors examine the incidence of radiation therapy and polypharmacy, medication documentation and review, effects on nutrition and its interplay with polypharmacy, management of toxicity and go on to give a clinical case example. They conclude the review with some pertinent points. This issue is only going to increase with time as more older adults have cancer treatment, the authors suggest measures to provide early detection and review of at risk patients, an interprofessional team approach for medication management and review as well as nutritional monitoring and assessment of toxicity risk. They suggest more studies are required to assist in the development of robust good practice guidelines.
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