Take the hyper out of pharmacotherapy
Barbara Ann M. Messina PhD, RN, ANP
Lori A. Escallier PhD, RN, CPNP

July 2011 
Volume 41  Number 7
Pages 51 - 53
  PDF Version Available!

ACCORDING TO THE U.S. CENSUS BUREAU, 38.9 million adults celebrated their 65th birthday between 1996 and 2010. The Census Bureau projects that by 2050, the number of Americans over age 65 will more than double to 88.5 million, representing nearly 20% of the population.1With increasing age comes the increasing likelihood of chronic diseases treated with multiple drugs. This article discusses the perils of multiple medications in older adults and explores strategies for preventing avoidable adverse reactions related to complex drug regimens.As the population ages, the healthcare system will be challenged to shift its emphasis from acute care to meeting the needs of chronically ill older adults, who typically require therapy with multiple drugs. For example, many patients with heart failure are treated with five or more medications.2-5Among patients age 55 and older, the most common diseases requiring pharmacotherapy (drug therapy) are arthritis, depression, heart disease, hypertension, and diabetes. When a patient is being treated for more than one chronic illness-for example, heart failure and diabetes-the drug burden and risk of adverse reactions increase exponentially.6Polypharmacy is often defined as the use of multiple medications to treat health problems.7 It's come to represent the inappropriate use of multiple medications rather than the rational use of concomitant drugs. Other ways of describing polypharmacy include bottle proliferation, an excessive number of prescriptive agents, high-frequency medications, multiple-dose medications, unnecessary use of medications, or use of more medications than are clinically indicated.8-11 Currently the preferred term to describe the excessive use of drugs to treat disease is hyperpharmacotherapy, because polypharmacy has taken on various meanings, including patients' use of multiple pharmacies to fill prescriptions.12,13To reduce hyperpharmacotherapy, perform frequent medication reconciliation for each patient while asking

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