Ethical dimensions of polypharmacy management in geriatric care: Interdisciplinary insights from nursing and pharmacy

https://doi.org/10.53730/ijhs.v3nS1.15391

Authors

  • Ruqiah Ali Alzaher KSA, National Guard Health Affairs
  • Mohammed Salem Alshammari KSA, National Guard Health Affairs
  • Dhafer Ahmed Ali Al-Shehri KSA, National Guard Health Affairs
  • Salman Mohammad Abdulraman Altulaih KSA, National Guard Health Affairs
  • Abdulaziz Abdullah Mughiran Alharbi KSA, National Guard Health Affairs
  • Ramzi Hasan Al Hamad KSA, National Guard Health Affairs
  • Nahar Khalif Al-Khaldi KSA, National Guard Health Affairs
  • Abdullah Abood AlBishi KSA, National Guard Health Affairs
  • Mutlaq Shabab Huwaydi Alotaibi KSA, National Guard Health Affairs
  • ‏Mesfer Hamed M Almalki KSA, National Guard Health Affairs

Keywords:

patient-centered care, pharmacy, geriatrics, interdisciplinary teamwork, nursing, adverse drug events, polypharmacy

Abstract

Background: The necessity to address comorbidities and chronic illnesses has led to a prevalent practice in geriatric care known as polypharmacy, or the concurrent use of numerous drugs. But there are serious ethical issues with polypharmacy, such as the possibility of adverse drug events (ADEs), diminished patient autonomy, and unequal resource distribution. The aging population and growing demands on healthcare systems make managing these problems even more difficult. In order to provide patient-centered, safe, and fair treatment, ethical polypharmacy management necessitates a multidisciplinary strategy that makes use of the knowledge of pharmacy and nursing specialists. Aim: this paper is to examine the moral implications of managing polypharmacy in geriatric care, with an emphasis on multidisciplinary approaches that tackle issues like resource allocation, patient safety, and informed consent. It emphasizes how pharmacy and nursing practitioners can maximize polypharmacy procedures while upholding moral standards. Methods: A thorough analysis of interdisciplinary literature was carried out, encompassing case studies, ethical frameworks, and clinical guidelines. With special emphasis to their ethical implications, the investigation concentrated on finding collaborative behaviors and successful treatments in polypharmacy management. 

Downloads

Download data is not yet available.

References

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

World Health Organization. (2017). Medication Without Harm: WHO Global Patient Safety Challenge. WHO.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Qato, D. M., et al. (2008). Changes in prescription and over-the-counter medication use among older adults in the United States. JAMA, 300(24), 2867–2878. DOI: https://doi.org/10.1001/jama.2008.892

Budnitz, D. S., et al. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012.

Guthrie, B., et al. (2015). The burden of polypharmacy in primary care. British Journal of General Practice, 65(641), e605–e612.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933.

Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy. Annals of Internal Medicine, 158(5), 397–403.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

O'Mahony, D., et al. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people. Age and Ageing, 44(2), 213–218.

Budnitz, D. S., et al. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012.

Maher, R. L., Hanlon, J. T., & Hajjar, E. R. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Rochon, P. A., & Gurwitz, J. H. (2017). Optimizing drug treatment for elderly people: The prescribing cascade. BMJ, 315(7101), 1096–1099. DOI: https://doi.org/10.1136/bmj.315.7115.1096

Kwan, J. L., Lo, L., Sampson, M., & Shojania, K. G. (2013). Medication reconciliation during transitions of care as a patient safety strategy. Annals of Internal Medicine, 158(5), 397–403. DOI: https://doi.org/10.7326/0003-4819-158-5-201303051-00006

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

Gnjidic, D., et al. (2012). Polypharmacy and health outcomes in older people. Journal of the American Geriatrics Society, 60(10), 1941–1942.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

O’Connor, M. N., Gallagher, P., & O’Mahony, D. (2012). Inappropriate prescribing: Criteria, detection, and prevention. Drugs & Aging, 29(6), 437–452.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

Duerden, M., Avery, T., & Payne, R. (2013). Polypharmacy and medicines optimization: Making it safe and sound. The King’s Fund.

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Hanlon, J. T., et al. (2017). Adverse drug events in high-risk older adults. Journal of Gerontology: Medical Sciences, 72(5), 789–795.

By the 2015 AGS Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227–2246.

O'Mahony, D., et al. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people. Age and Ageing, 44(2), 213–218.

Masnoon, N., et al. (2017). What is polypharmacy? A systematic review of definitions. BMC Geriatrics, 17(1), 230. DOI: https://doi.org/10.1186/s12877-017-0621-2

Budnitz, D. S., et al. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012.

Gallagher, P., et al. (2011). STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria: A comprehensive evidence-based approach to the use of potentially inappropriate medication in older people. Age and Ageing, 40(5), 673–678.

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98.

Gnjidic, D., et al. (2012). Polypharmacy and health outcomes in older people. Journal of the American Geriatrics Society, 60(10), 1941–1942.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

O'Mahony, D., et al. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people. Age and Ageing, 44(2), 213–218.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Budnitz, D. S., et al. (2011). Emergency hospitalizations for adverse drug events in older Americans. New England Journal of Medicine, 365(21), 2002–2012. DOI: https://doi.org/10.1056/NEJMsa1103053

By the 2015 AGS Beers Criteria Update Expert Panel. (2015). American Geriatrics Society 2015 updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 63(11), 2227–2246. DOI: https://doi.org/10.1111/jgs.13702

Gallagher, P., et al. (2011). STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria: A comprehensive evidence-based approach to the use of potentially inappropriate medication in older people. Age and Ageing, 40(5), 673–678.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98.

Gnjidic, D., et al. (2012). Polypharmacy and health outcomes in older people. Journal of the American Geriatrics Society, 60(10), 1941–1942.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

O’Connor, M. N., Gallagher, P., & O’Mahony, D. (2012). Inappropriate prescribing: Criteria, detection, and prevention. Drugs & Aging, 29(6), 437–452.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933.

O’Mahony, D., et al. (2015). STOPP/START criteria for potentially inappropriate prescribing in older people. Age and Ageing, 44(2), 213–218. DOI: https://doi.org/10.1093/ageing/afu145

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Gallagher, P., et al. (2011). STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria: A comprehensive evidence-based approach to the use of potentially inappropriate medication in older people. Age and Ageing, 40(5), 673–678.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

O’Connor, M. N., Gallagher, P., & O’Mahony, D. (2012). Inappropriate prescribing: Criteria, detection, and prevention. Drugs & Aging, 29(6), 437–452.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

O’Connor, M. N., Gallagher, P., & O’Mahony, D. (2012). Inappropriate prescribing: Criteria, detection, and prevention. Drugs & Aging, 29(6), 437–452.

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834.

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

Gallagher, P., et al. (2011). STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria: A comprehensive evidence-based approach to the use of potentially inappropriate medication in older people. Age and Ageing, 40(5), 673–678.

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

Gallagher, P., et al. (2011). STOPP (Screening Tool of Older Persons’ Prescriptions) and START (Screening Tool to Alert to Right Treatment) criteria: A comprehensive evidence-based approach to the use of potentially inappropriate medication in older people. Age and Ageing, 40(5), 673–678.

Scott, I. A., et al. (2015). Reducing inappropriate polypharmacy: The process of deprescribing. JAMA Internal Medicine, 175(5), 827–834. DOI: https://doi.org/10.1001/jamainternmed.2015.0324

Holmes, H. M., et al. (2013). Rationalizing prescribing for older adults. Clinical Interventions in Aging, 8, 673–689.

Chisholm-Burns, M. A., et al. (2010). US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Medical Care, 48(10), 923–933. DOI: https://doi.org/10.1097/MLR.0b013e3181e57962

Beauchamp, T. L., & Childress, J. F. (2013). Principles of Biomedical Ethics. Oxford University Press.

Fairman, K. A., et al. (2012). Disparities in medication access and adherence. Journal of Managed Care Pharmacy, 18(6), 426–428.

Maher, R. L., et al. (2014). Clinical consequences of polypharmacy in elderly: Expect the unexpected. Therapeutic Advances in Drug Safety, 5(4), 209–219.

O’Connor, M. N., Gallagher, P., & O’Mahony, D. (2012). Inappropriate prescribing: Criteria, detection, and prevention. Drugs & Aging, 29(6), 437–452. DOI: https://doi.org/10.2165/11632610-000000000-00000

Marcum, Z. A., & Gellad, W. F. (2012). Medication adherence to multidrug regimens. Clinical Geriatrics Medicine, 28(2), 287–300. DOI: https://doi.org/10.1016/j.cger.2012.01.008

Weiss, B. D., & Blanchard, J. S. (2016). Low health literacy and outcomes of polypharmacy in elderly patients. Journal of Health Communication, 21(S1), 91–98. DOI: https://doi.org/10.1080/10810730.2016.1184359

Holmes, H. M., et al. (2015). Evidence-based approaches to deprescribing in older adults. Clinical Geriatric Medicine, 31(2), 165–178. DOI: https://doi.org/10.1016/j.cger.2017.01.004

Green, A. R., et al. (2014). Implicit bias and its role in prescribing patterns for elderly populations. Social Science & Medicine, 128, 128–135.

Maher, L., et al. (2016). Ethical dilemmas in polypharmacy: The role of patient autonomy and beneficence. Ethics & Medicine, 32(3), 173–180.

Published

15-01-2019

How to Cite

Alzaher, R. A., Alshammari, M. S., Al-Shehri, D. A. A., Altulaih, S. M. A., Alharbi, A. A. M., Al Hamad, R. H., Al-Khaldi, N. K., AlBishi, A. A., Alotaibi, M. S. H., & Almalki, ‏Mesfer H. M. (2019). Ethical dimensions of polypharmacy management in geriatric care: Interdisciplinary insights from nursing and pharmacy. International Journal of Health Sciences, 3(S1), 498–524. https://doi.org/10.53730/ijhs.v3nS1.15391

Issue

Section

Peer Review Articles

Most read articles by the same author(s)

1 2 > >>