Year of Publication

2015

Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Martha Biddle

Clinical Mentor

Dr. Demetra Antimisiaris

Committee Member

Dr. Carolyn Williams

Abstract

“The impending crisis, which has been foreseen for decades, is now upon us.The nation needs to act now to prepare the health care workforce to meet the care needs of older adults.” Institute of Medicine.

Given the rising tide of people over the age of 65, taking multiple medications or polypharmacy is a becoming more prevalent in older adults. Unfortunately, there are many negative consequences associated with polypharmacy. Specifically, this burden has been associated with greater health care costs and an increased risk of adverse drug events, drug-interactions, medication non-adherence, reduced functional capacity and multiple geriatric syndromes including cognitive impairment. Cognitive impairment, seen with both delirium and dementia, has been associated with polypharmacy. Current medical practice guidelines often require multiple medications to treat each chronic disease state for optimal clinical benefit. Cognitive impairment can put a patient at risk for either under- or overtreatment due to their numerous chronic illnesses requiring treatment.

In Primary Care, the burden of polypharmacy can be daunting, especially when patient visit times are short and there are other issues to be addressed. There is a lack of an evidence-based, step-by-step protocol to address polypharmacy in Primary Care that can take the healthcare provider and patient through the medication list together, efficiently. If there was such an instrument, polypharmacy could be focused on and adverse reactions such as hospitalizations, falls, and cognitive impairment could be avoided. The purpose of this DNP project is to investigate the impact of polypharmacy on older adults and what is available in the literature to address this problem in primary care. Then implement a streamlined Polypharmacy Protocol in this type of setting to investigate its positive and negative attributes for future use to apply to the problem of polypharmacy.

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