References
Pharmacology, polypharmacy and the older adult: a review
Abstract
District nurses routinely visit and care for older patients who are prescribed multiple medicines. Older people living with multiple comorbidities and polypharmacy are commonly encountered in community nursing. It is important for nurses to recognise that regular medicines use and age-related physiological changes in older people place them at greater risk of medication-related harm. In order to understand this, an underpinning knowledge of the pharmacological principles relating to older people is required. This review will consider the effects of age-related changes and the impact of ageing on pharmacokinetics and pharmacodynamics. The relationship between polypharmacy and identifying high-risk drugs and adverse drug events will be explored. Medicines use in older adults with multimorbidity including frailty will be discussed. The role of district nurses in supporting older people with medicines optimisation will be considered, with a focus on how the community nurse can contribute to reducing avoidable harm for patients.
Prescribing a medicine is the most common clinical intervention in the NHS (National Institute for Health and Care Excellence (NICE), 2015). The trend in prescribing continues to grow year on year and the number of prescription items dispensed increased from 2006 to 2016 by 47% (NHS Digital, 2016). Prescribing in older people is very common, and it is estimated that, in England, more than 1 in 10 people aged over 65 years take at least eight different prescribed medications each week. This increases to nearly one-in-four among those aged over 85 years (Age UK, 2019).
Ageing brings about a number of changes in the body, and the ageing process begins to affect the way the body handles medicines around the time a person reaches their forties.
A combination of pharmacokinetic, pharmacodynamic and homeostatic changes slowly develops and becomes clinically significant as the person gets older. There is considerable variation in the onset rate and extent of significance. Biological age is a more important indicator than chronological age when trying to identify an older person who is at risk of an adverse reaction to prescribed medications.
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