Polypharmacy in older people: The need for deprescribing

Abstract

As Gerri Kaufman explains, practice nurses play a key role in supporting older people with long-term conditions who may benefit from deprescribing Multimorbidity, the existence of two or more long-term conditions, and polypharmacy, the use of multiple medicines, are common in older people. Polypharmacy is classed as either appropriate or problematic. Altered pharmacokinetics (how the body handles a drug), and pharmacodynamics (how drugs work in the body), coupled with polypharmacy have the potential to increase the risk of adverse drug events in older people. Adverse drug events include drug-to-drug interactions and adverse drug reactions. It remains unclear whether interventions such as medication reviews, the use of risk screening tools and computerised decision support, implemented to improve appropriate polypharmacy, result in clinically significant improvements. There is growing evidence of the benefits and safety of deprescribing in polypharmacy, which strengthens the case for greater integration of the process into clinical practice. Nurses in general practice play a key role in supporting older patients with long-term conditions and multimorbidity, and therefore have a role to play in deprescribing decisions, and in supporting patients to make such decisions.