94 Polypharmacy in older adults: the role of the advanced nurse practitioner

Abstract Background Polypharmacy is the concurrent use of five or more medications and is more prevalent in the care of Older Persons. Polypharmacy is a global issue and is linked to poor health outcomes especially in Older Persons. It is estimated that 20% of people over 65 years of age in Ireland, are prescribed at least 10 drugs repeatedly and 5% are prescribed at least 15 drugs repeatedly. Prescribing and deprescribing medication is a complex process and it can be challenging for people who are over 65 years of age It is estimated that people taking more than 10 medicines are twice as likely to develop frailty; frail cohort were twice as likely to be prescribed a potentially inappropriate medication and three times likely to be admitted to hospital. Over 10% of emergency hospital admissions in this cohort were estimated to be related to adverse drug reactions. Appropriate deprescribing will improve patient outcomes and reduce healthcare costs. Methods The Registered Advanced Nurse Practitioner populated a database of all medications that were prescribed and deprescribed within the caseload over the two year period. STOPP/START tool was used for deprescribing. Results The study confirmed that Appropriate Prescribing is a person-centred intervention, which required up-to-date knowledge of the patient’s condition, review of medical notes and/or co-ordinating with Pharmacist and/or General Practitioner (GP) to obtain the full list of medication, shared decision-making, monitoring for adverse effects, monitoring laboratory values and routine follow up. Patient engagement and education was vital to achieve positive outcomes. Encouraging the use of unit dose packaging for this cohort was noted to be an effective method of medication adherence. Conclusion The study recommends regular medications reviews for patients on Polypharmacy. Future changes in the healthcare should include electronic prescribing, improved access to medical records for Primary and Secondary care to improve prescribing in Older Persons.