Poly pharmacy
Prepard by:
Group (B2 )
Head of department
Dr / Manal Mansor
Under supervision of
Dr / Hasnaa Korany
Faculty of Nursing Fayoum University
2024-2025
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Prepared by:
Mohamed Hesham Attia
Mohamed Youssef Mohamed
Mahmoud Ismail Ramadan
Mahmoud Ragab Ali
Mahmoud Ragab Mahmoud
Mahmoud Saeed Mohamed
Mahmoud Sayed Hassan
Mahmoud Abdel Aati
Mahmoud Ali Abdel Moaty
Mahmoud Qarni Ahmed
Mahmoud Mohamed Abdel Wahid
Mahmoud Mohamed Ajami
Mahmoud Mohamed Mahmoud
Mahmoud Mohamed Mustafa
Mahmoud Mamdouh Haroun
Mukhtar Ayman Mukhtar
Medhat Adel Saad
Marwan Abdel Rahman Helmy
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Marwa Galal Kamel
Marwa Gamal Ahmed
Marwa Saad Aziz
Marwa Mahmoud Hamad
Marwa Masoud Rabie
Maryam Ahmed Abdel Moneim
Maryam Hossam Hussein Maryam
Khaled Salah
Maryam Khairallah Sayed
Maryam Abdel Tawab Abdel Zaher
Maryam Karam Makin
Maryam Magdy Atta
Maryam Mohsen Darwish
Maryam Mahmoud Tawfiq
Maryam Mostafa Kamel
Maryam Nasser Hassan
Mustafa Ahmed Mohamed
Mustafa Gamal Saad
Mustafa Reda Hassan
Mustafa Mohamed Alwani
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Mustafa Mahmoud Ramadan
Moaz Adel Abdel Tawab
Malek Mahmoud Mohamed
Malek Walid Hamdy
Mamdouh Abdel Razek Ali
Manar Ashraf Ali
Manar Gomaa Helmy
Manar Khaled Al-Dawlaty
Outlines:
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Introduction
Definition
Causes
Risk Factors
Signs and Symptoms
Diagnosis
Effective Of Polypharmacy on Elderly
Side Effects Of Polypharmacy on Elderly
Prevention ( First / Second / third )
Role of geriatric home nursing according to poly
pharmacy
Nursing care plan of Polypharmacy
Health Education
Reference
Introduction:
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Polypharmacy is a growing concern, especially among
older adults, due to the increasing prevalence of chronic
diseases requiring multiple medications. While
medications play a vital role in managing health
conditions, their excessive use can lead to potential harm
With a significant percentage of older adults taking
multiple drugs daily, balancing effective treatment with
minimizing risks is crucial in healthcare.
Definition:
Polypharmacy, defined as the regular use of 5 or more
medications at the same time, is common in older adults
and at-risk younger individuals.
As aging individuals often contend with multiple chronic
health conditions, the use of 5 or more medications
becomes common, posing risks of adverse outcomes
such as falls, frailty, disability, and mortality.
Causes:
1-Multiple Medical Conditions: Older adults with
several chronic diseases often require multiple
medications to
manage each condition.
2-Multiple Healthcare Providers: Different specialists
may prescribe medications without being fully aware of
what others have prescribed.
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3-Lack of Communication: Poor communication and
coordination between healthcare providers, pharmacists,
and older adults can lead to overlapping or unnecessary
prescriptions.
4-Self-Medication: Older adults may take over-
thecounter drugs, supplements, or herbal remedies
without
consulting their healthcare provider.
5-Aging Population: Older adults are more likely to
have multiple health issues requiring various
medications.
6-Prescription Cascade: This occurs when side effects
of a medication are misinterpreted as a new medical
condition, leading to the prescription of additional
medications.
7-Dependence on Medications: Some individuals
rely on medications as a quick solution to health
problems without addressing underlying causes.
8-Irregular Review of Medications: Failure to
regularly review medications with a healthcare provider
can result in continued use of unnecessary medications.
9-Incorrect Prescribing: Medications may be
prescribed without a true need, leading to an increase in
the number of medications taken.
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10-Side Effects: Certain medications can cause side
effects that require additional medications to manage.
Risk Factors:
Polypharmacy may become problematic in older adults under
these condition:
1-The presence of multiple medical problems and taking
multiple medication.
2-Reduced homeostatic mechanisms, due to a decrease
in physiologic reserve or the presence of organ
dysfunction, especially renal impairment.
3-The presence of frailty or factors associated with
frailty.
4-Acute illness or medication changes (including adding
medications or increasing the dose of existing new
medications).
These factors can lead to problematic polypharmacy in
an adult and should be kept in mind when reviewing a
Older adult‘s medication regimen.
Signs and Symptoms:
1-Reduced alertness
2-Confusion or cognitive problems
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3-Falls and accidents
4-Weakness and dizziness
5-Loss of appetite
6-GI problems such as diarrhea, constipation or
incontinence 7- Skin rashes
8- Depression
9- Anxiety
10- Excitability
Diagnosis:
The fact that the elderly take more medications for the
treatment of several diseases makes them more
susceptible to the occurrence of adverse reactions.
Prophylactic actions such as balanced prescriptions are
vital to reduce the incidence of these reactions and
prevent longer hospital stay, increased costs and
aggravation of the older adults health condition
Polypharmacy, generally defined as the concurrent use of
multiple medications, is a common concern in geriatrics
due to the unique physiological changes that occur with
aging, as well as the prevalence of multiple chronic
conditions among older adults. Diagnosing and
managing polypharmacy involves several key
considerations:
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1-Definition and Criteria:
Polypharmacy is often defined as the use of five or
more medications. However, it can also be assessed based
on the appropriateness of the medications rather than just
the number.
Appropriate Polypharmacy refers to the use of
multiple medications that are necessary and beneficial
for the older adult's health conditions, while
Inappropriate
Polypharmacy refers to the use of medications that may
not be needed or that pose more risks than benefits.
2-Assessment Tools:
Medication Review: A thorough review of all
medications (prescription, over-the-counter, herbal
supplements) is essential.
Beers Criteria: This tool helps identify potentially
inappropriate medications for older adults.
STOPP/START Criteria: These criteria help assess potentially
inappropriate prescriptions and identify
appropriate prescribing for older adults.
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3-Clinical Evaluation:
Comprehensive Geriatric Assessment (CGA): This
includes evaluating medical, psychological, and
functional aspects of the older adult’s health.
Medication History: Gather detailed information about
all current medications, including indications, dosages,
duration of therapy, and any recent changes.
Review for Drug Interactions: Assess for potential
drug-drug interactions and adverse effects.
4-Identifying Risks:
Adverse Drug Reactions (ADRs): Older adults are at
higher risk for ADRs due to altered pharmacokinetics
and pharmacodynamics.
Cognitive Impairment: Polypharmacy can contribute
to cognitive decline or exacerbate existing cognitive
issues.
Functional Decline: Increased medications can lead to
falls, frailty, and decreased quality of life.
5-Management Strategies:
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Deprescribing: This involves systematically
discontinuing unnecessary or harmful medications.
Older adults-Centered Approach: Engage patients in
discussions about their medications, focusing on goals of
care and preferences.
Regular Follow-Up: Continuous monitoring and
reassessment of medication regimens are crucial.
6-Education and Communication:
Educate patients and caregivers about the importance
of medication management and potential side effects.
Encourage open ommunication regarding any new
symptoms or concerns related to medications.
Effective of poly pharmacy:
Polypharmacology, the use of multiple medications to
treat various conditions, is common in elderly
individuals
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due to the prevalence of multiple chronic diseases.
While it has potential benefits, it also comes with
significant risks.
Benefits of Polypharmacology in the Elderly:
1-Comprehensive Disease Management – Helps in
managing multiple chronic conditions like hypertension,
diabetes, and arthritis effectively.
2-Improved Quality of Life – Proper medication
regimens can enhance mobility, cognition, and daily
functioning.
3-Reduced Hospitalization Rates – When carefully
managed, polypharmacology can prevent complications
and reduce the need for emergency care.
Risks and Challenges:
1-Increased Risk of Adverse Drug Reactions (ADRs) –
The older adults have altered drug metabolism, making
them more prone to side effects.
2-Drug-Drug Interactions – Multiple medications
increase the chances of harmful interactions, leading to
toxicity or reduced effectiveness.
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3-Medication Non-Adherence – Complex regimens can
lead to confusion, missed doses, or overdosing. 4-
Cognitive and Functional Decline – Some medications,
especially sedatives and anticholinergics,
may contribute to memory loss or falls.
5-Financial Burden – Polypharmacy can be costly,
leading to financial strain on elderly patients.
Strategies to Optimize Polypharmacology:
Medication Review – Regular assessment by healthcare
providers to deprescribe unnecessary drugs.
Personalized Prescribing – Adjusting doses based on
renal and hepatic function
Use of Medication Management Tools – Pill organizers
and electronic reminders can enhance adherence.
Older adults and Caregiver Education – Ensuring
understanding of drug regimens, side effects, and
interactions.
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While polypharmacology is often necessary for older
adults, careful management is crucial to balance benefits
and risks. Regular medication reviews and personalized
treatment plans can significantly improve outcomes.
Side effect of poly pharmacy:
Multi-Morbidity:
Aging places individuals at risk of multi-morbidity
(coexistence of 2 or more chronic health conditions) due
to associated physiological and pathological changes and
increases the chances of being prescribed multiple
medications.
Adverse Drug Effects:
An adverse drug effect (ADE) is an injury from drug use.
An adverse drug reaction (ADR) is an ADE that refers to
harm caused by a drug at usual dosages.
Drug Interactions:
Multiple medications increase the potential for drug-drug
interactions and the prescription of potentially
inappropriate medications. A drug-drug interaction refers
to the pharmacologic or clinical response to
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administering a drug combination that differs from the
response expected from the known effects of each of
these 2 agents when given alone. Cardiovascular drugs
are most commonly involved in drug-drug interactions.
Medication Non-Adherence:
Polypharmacy can lead to problems with medication
adherence in older adults, especially if associated with
visual or cognitive decline, associated with aging, and
resulting in bad outcomes like treatment failure or
hospitalizations.
Prescribing Cascades:
Polypharmacy increases the possibility of prescribing
cascades when additional drugs are prescribed to treat
adverse effects (ADE) of other drugs.
I Prevention:
Polypharmacy in older adults refers to the use of multiple
medications simultaneously, which can lead to adverse effects, drug
interactions, and other complications. Preventing polypharmacy is
essential for improving health outcomes in older adults. The
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strategies can be broken down into three levels of prevention:
primary, secondary, and tertiary prevention.
1. Primary Prevention:
Primary prevention aims to stop polypharmacy before it starts by
promoting healthy behaviors, minimizing the need for medications,
and fostering good prescribing practices.
Older adults education: Encourage healthy lifestyle choices like
proper nutrition, exercise, and preventive care to avoid or delay the
onset of chronic diseases that require medications.
Appropriate prescribing guidelines: Ensure that clinicians adhere to
evidence-based prescribing guidelines, particularly for older adults,
and avoid unnecessary medications.
Regular reviews of the medication regimen: Establish systems for
early detection of unnecessary prescriptions, especially during the
initial stages of chronic disease management.
Shared decision-making: Involve older adults in conversations
about treatment goals and the need for medications, ensuring that
they understand the potential risks and benefits of each drug.
Non-pharmacologic interventions: Promote the use of alternatives
to medication, such as physical therapy, lifestyle modifications, and
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psychological therapies, for managing conditions like chronic pain
or anxiety.
2. Secondary Prevention: ( early detection and early treatment )
Secondary prevention involves early detection of polypharmacy and
interventions aimed at reducing the number of medications used and
minimizing harm.
Medication reviews: Conduct regular medication reviews with
healthcare providers to assess the appropriateness of each drug.
This includes reviewing potential drug-drug interactions, side
effects, and the necessity of each medication.
Deprescribing: Develop a plan for discontinuing unnecessary or
harmful medications, gradually and safely, to reduce the medication
burden.
Adverse drug reaction monitoring: Regularly monitor for adverse
drug reactions, especially when new medications are added or when
doses are adjusted.
Coordination of care: Ensure effective communication between
specialists and primary care providers to avoid duplicative or
conflicting prescriptions.
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Polypharmacy risk tools: Use validated tools such as the Beers
Criteria or STOPP/START criteria to identify potentially
inappropriate medications for older adults.
3. Tertiary Prevention: (Rehabilitation)
Tertiary prevention focuses on managing and minimizing the harm
already caused by polypharmacy, improving quality of life, and
preventing further complications.
Manage complications: Address complications related to
polypharmacy, such as falls, cognitive decline, or hospitalizations
due to adverse drug reactions.
Support systems: Provide support for medication management,
including reminders, pill organizers, or caregiver assistance, to
ensure that patients take their medications safely and as prescribed.
Palliative care and end-of-life discussions: In patients with
advanced illness or limited life expectancy, consider stopping
medications that do not contribute to quality of life, focusing on
comfort and symptom management instead.
Rehabilitation and recovery programs: Offer physical and
occupational therapy to help older adults recover from the adverse
effects of polypharmacy, such as muscle weakness or falls.
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By addressing polypharmacy at these different levels, healthcare
providers can help older adults achieve better health outcomes,
reduce the risk of medication-related harm, and improve their
overall quality of life.
Role of geriatric home nursing according to poly
pharmacy:
1-Medication management and monitoring:
Nurses help ensure that medication are taken correctly,
on time, and in the right dosages. They may also monitor
for potential side effects, drug interactions, or adverse
reactions, which are more common in older adults.
2-Assessment and Review of Medication:
Geriatric nurses collaborate with physicians to assess the
appropriateness of each medication. This includes
reviewing medication regularly to ensure they are still
necessary and identifying any that might be redundant or
harmful.
3-Patient and caregiver Education:
Nurses educate both patients and thier caregiver about
the risks of polypharmacy, proper medication
administration, and potential side effects, empowering
them to make informed decisions about treatment.
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4-Promoting Adherence:
Nurses play a key role in helping patients adhere to their
prescribed medication by providing support, reminder,
and strategies to manage complex medication schedules.
5-Advocacy and coordination:
Geriatric nurses act as advocate, communicating with
other healthcare providers to address concerns related to
polypharmacy and ensure coordinated care across
different specialist and healthcare teams.
6-Preventing Drug - Related problems:
By monitoring and assessing drug therapy, nurses can
prevent medication - related complications such as falls ,
cognitive decline and other adverse effects.
Health education:
1-Older adults Education:
Explain the purpose, dosage, and side effects of each
medication.
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Use simple language and visual aids for better
understanding.
Encourage the use of pill organizers and medication apps
for adherence.
2-Caregiver Involvement:
Educate caregivers on medication management and
monitoring for side effects.
Provide clear instructions on administering medications.
3-Tools and Resources:
Recommend pill organizers, medication apps, and
educational brochures.
Use the teach-back method to ensure understanding.
4-Regular Follow-ups:
Schedule regular medication reviews with healthcare
providers.
Advise older adults to bring all medications, including
OTC drugs and supplements, to appointments.
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5-Addressing Barriers:
Help older adults overcome financial, physical, or
psychological barriers
to adherence.
Promote non-pharmacological interventions like lifestyle
changes and alternative therapies.
6-Why It Matters:
Reduces medication errors and improves adherence.
Prevents adverse outcomes like hospitalizations.
Empowers patients and caregivers to manage
medications effectively.
Nursing Goal Nursing Evaluation
Diagnosis Intervention
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Decrease in Short-Term Nursing Assessment: Evaluation :
Alertness Goals:
1.Patient History Improved evidenced
related to: side 1.Medication by
effects of Medical History:
Understanding:
medications 1.Cognitive
Chronic illnesses (e.g.,
affecting -The patient Function:
will correctly hypertension, diabetes,
neurotransmitter depression). Improved orientation
balance. verbalize the
to person, place, and
purpose and Previous episodes of
time within 72 hours
dosage of each confusion or cognitive
after medication
Subjective medication impairment.
review.
data: they are taking
Medication History:
within 48 Visual hallucinations
1-Patient Reports: List of current
hours. and misperceptions
I often forget if I took my medications improved with dose
2.Cognitive
morning pills. (prescription and over- adjustments and
Function
the-counter). deprescribing.
Sometimes I feel dizzy or Monitoring:
lightheaded after taking my Allergies: Improved short-term
-The patient
medications. Document any known memory, evidenced
will
allergies and reactions by the patient
2-Family Reports: demonstrate
to medications. recalling recent
We've noticed changes in improved
events and following
her memory and mood. orientation (to 2.Cognitive instructions
person, place, Assessment
She seems more and time) accurately.
disoriented, especially in Orientation:
during daily
the evenings. assessments Assess orientation to
within one person, place, time, and
week. situation 2. Medication
Objective data:
3.Medication Memory: Safety:
1-Cognitive Assessment: Management:
Evaluate shortterm and Improved adherence
Mini-Mental State -The patient long-term memory to a simplified
Examination (MMSE) will utilize a through simple recall medication regimen
score indicating mild pill organizer tasks. without further
cognitive impairment. or medication cognitive
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2-Disorientation to time or management Mini-Mental State impairment.
place during conversations. system Examination (MMSE):
Caregivers
effectively by
Administer the MMSE demonstrated
the next
or other cognitive understanding of
3-Vital Signs: medication
assessment tools to medication
Blood pressure: 130/85 review
quantify cognitive management,
mmHg (medication-related appointment.
function. enhancing patient
hypotension suspected). 4.Family safety.
3.Physical Assessment
Heart rate: 78 bpm, Involvement:
3. Behavioral and
Vital Signs:
regular. -The family Emotional Well-
will participate Monitor blood Being:
4-Physical Examination:
in medication pressure, heart rate,
Signs of dehydration (dry Improved mood and
education respiration, and
mucous membranes). temperature. reduced anxiety
sessions and
related to confusion.
Diminished attention span demonstrate Neurological
noted during the proper Examination: Hallucinations
assessment. medication decreased, and the
Assess for any signs of patient responded
5-Laboratory Results: administration
neurological deficits appropriately to
techniques
Recent blood work (e.g., weakness,
within 72 surroundings.
showing normal renal numbness).
hours.
function but elevated liver Hydration Status:
4. Functional
Long-Term Independence:
enzymes (potential impact
Goals Look for signs of
of medications). dehydration (e.g., dry
1.Cognitive
mucous membranes, Improved ability to
Stability:
skin turgor). perform daily
-The patient activities with
General Appearance:
will maintain minimal assistance.
cognitive Observe the patient’s
function and level of alertness, The patient engaged
demonstrate no mood, and behavior. more in social
further interactions and
4.Medication Review reported a better
episodes of
Polypharmacy Risks: quality of life.
confusion or
disorientation Identify potential drug 5. Patient Education
over the next
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month. interactions and side and Monitoring:
effects.
2.Medication The patient and
Adherence: Adherence caregiver
demonstrated
-The patient Assess the patient's
improved
will adhere to understanding of their
understanding of
the prescribed medication regimen
medication and ability to adhere to medication purposes,
regimen with it. side effects, and safe
no missed use.
5.Functional
doses or Assessment Health Education for
medication Confusion Related to
errors reported - Activities of Daily Polypharmacy
over the next Living (ADLs):
three months. 1. Understanding
-Evaluate the patient’s Polypharmacy:
3.Reduction of ability to perform
Side Effects: Polypharmacy refers
ADLs independently
to the use of multiple
-The patient (e.g., bathing, dressing,
medications, often
will report a eating).
seen in older adults
decrease in -Instrumental Activities with chronic
medication- of Daily Living conditions.
related side (IADLs):
effects (e.g., It increases the risk
dizziness, -Assess abilities related of confusion,
confusion) to managing hallucinations, falls,
within six medications, finances, and other side effects
and transportation. due to drug
weeks, as
assessed interactions.
through 2. Medication
Nursing Interventions
ongoing Management:
evaluation. 1.Medication Review:
Always follow the
- Rationale: Regularly
medication schedule.
review all medications
with the patient and Avoid self-
healthcare team to medicating or using
identify unnecessary over-the-counter
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prescriptions, potential drugs without
drug interactions, or consulting a
duplicate therapies. healthcare provider.
2. Simplify Medication Use a pill organizer
Regimen: to prevent missed or
duplicate doses.
- Rationale:
Simplifying the Regularly update the
medication schedule medication list and
(e.g., using share it with all
combination pills or healthcare providers.
reducing the number of
3. Recognizing Side
doses per day) can help Effects:
improve adherence and
reduce confusion. Report signs of
confusion, dizziness,
3.Educate the Patient
memory loss, or
and Family:
visual hallucinations
- Rationale: Providing immediately.
education about each Monitor for physical
medication's purpose, changes, such as
dosage, and potential fatigue, weakness
side effects can
empower the patient
and family, promoting
better management and
awareness.
4.Use Medication
Management Tools:
- Rationale: Utilize pill
organizers, medication
calendars, or reminder
apps to help the patient
track their medications
and reduce the risk of
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missed doses or
confusion.
5.Monitor Cognitive
Function:
-Rationale: Regularly
assess the patient's
cognitive status to
detect any changes
early, allowing for
timely interventions or
adjustments in
medication.
6.Encourage a Routine
-Rationale:
Establishing a daily
routine that includes
medication times can
provide structure,
helping reduce
confusion and anxiety
regarding medication
management.
Health Education
Topics:
1.Understanding
Polypharmacy:
-Definition:Explain
what polypharmacy is
and why it can pose
risks, including
confusion and potential
drug interactions.
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-Importance of
Awareness: Encourage
awareness of all
medications being
taken, including over-
the-counter drugs and
supplements.
2.Medication
Management:
-Keeping a Medication
List:Teach the patient
to maintain an updated
list of all medications,
including dosages and
schedules.
-Using Pill Organizers:
Introduce the use of pill
organizers or
medication reminders
to help manage daily
doses.
3.Recognizing Side
Effects:
-Common Symptoms:
Educate about common
side effects that can
lead to confusion, such
as dizziness,
drowsiness, or changes
in mood.
-When to Seek Help:
Encourage the patient
to report any new or
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worsening symptoms to
their healthcare
provider immediately.
4.Communication with
Healthcare Providers:
-Open Dialogue: Stress
the importance of
discussing all
medications with
healthcare providers,
including any changes
in health status or new
symptoms.
-Questions to Ask:
Provide a list of
questions to ask about
medications, such as
purpose, side effects,
and interactions.
6.Lifestyle
Modifications:
-Healthy Diet:
Encourage a balanced
diet to support overall
health and cognitive
function.
-Hydration: Stress the
importance of staying
hydrated, as
dehydration can worsen
confusion.
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Reference:
National library of Medicine World Health
Organization (WHO).
American Geriatrics Society (AGS).
National Institute on Aging (NIA).
Articles on polypharmacy and Geriatric Care.
British Geriatrics Society (BGS).
Journal of the American Medical Association
(JAMA).
Polypharmacy and Medication Safety in Older Adults.
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