Polypharmacy is a multi-million dollar problem in healthcare today; patients prescribed more than 4-6 medications can fall prey to various adverse effects, including falls, confusion, and even toxicities.
Regular medication reviews are vital to minimize the effects of multiple daily prescriptions. For our older patients, we have two major publications we can use as resources to help reduce prescription drug use.
The Beers criteria is a published list of medications that should be avoided or used cautiously in patients over 65. Most of these drugs are anticholinergic and can significantly impact hydration and cognitive status, especially when taken long-term.
Another great resource to consider is the STOPP/START criteria; this list provides safer options for many classes of drugs you can use instead of those included on the STOPP list. The STOPP list is a Screening Tool for Older Persons’ potentially inappropriate Prescriptions and provides excellent guidance for safer and less safe medications for elders.
If you find that a patient truly needs to take one of the less safe medications from these lists, it is highly recommended that you teach about this med and its potential effects to the patient and, if possible, a family member. Frequent follow-up is also recommended so you can thoroughly assess for any problems.
Deprescribing medications in patients 50 and over is recommended whenever possible. Always weigh risks vs. benefits, especially with our older clients.