Articles Posted in Drugs & Polypharmacy

Many people today use medication unnecessarily. The smallest flu or cold warrants the use of antibacterial medication that often does greater harm to our bodies. We ask our doctors for medications that cure common illnesses without thinking of the effects that these medicines may have on our bodies in the future. A rising concern in the medical field is the emergence of antimicrobial-resistant microorganisms (ARMs). Although resistance to antimicrobial organisms is a natural occurrence, over the years the cases of ARMs have been rapidly growing. The over-consumption and misuse of medication has created antimicrobial resistance on every continent.

An increasing worry is that soon common diseases, such as pneumonia and tuberculosis, will become fatal to those that acquire them. With an increased exposure to antimicrobial medicines, these diseases may continue to develop a stronger resistance to medications used now, creating a possibility that they may not work in the future. Resistant strains of bacteria are caused by inappropriate prescription of antibiotics when the patient truly doesn’t need them, or a misuse by the patient, for example stopping the use of the medication before the infection is fully treated. ARMs can cause post operation infections, result in limb loss, or complications in the central nervous system. A report  recently published by the OECD estimates that globally, at least 70,000 people die a year due to these resistant bugs.

Not only are ARMs a health risk, they have now become a financial burden. It takes hospitals more time, resources, and money to treat infected patients. The OECD report estimates that an additional 10,000 to 40,000 USD are spent treating patients infected by an ARM. In addition, global markets are also affected by these resistant microorganisms. In 2015 chicken sales in Norway dropped by 20% after news got out that a resistant strain of E. coli was found in the meat.

Falling is a common occurrence and a serious problem among the elderly population.  A myriad of studies has found that the use of psychotropic drugs on older adult patients in nursing homes significantly increases the risk of falling.  A recent study published by the Journal of the American Medical Directors Association (JAMDA) examined the relationship between fall occurrence and the prescription of psychotropic drugs and various categories of psychotropic drugs, such as antidepressants, antipsychotics, and benzodiazepines, among a representative nursing home population.

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According to a recent report by the International Psychogeriatrics Association, one in five older adults living in Europe with a functional impairment receives long-term care in a long-term care facility.  Over 50% of these older adults suffer with dementia and often are challenged by some kind of neuropsychiatric symptoms throughout the progression of the disease.  These patients commonly express challenging behaviors that include verbal and physical aggression, depression, agitation, wandering, sleep disturbances, oppositional behaviors, and psychotic symptoms.  Presently, not many pharmacologic options exist for the treatment of neuropsychiatric symptoms.  However, elderly residents with dementia are frequently prescribed psychotropic medications.

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Older adults, especially those residing in assisted living facilities, are highly vulnerable to dangerous drug-drug interactions (DDIs) because of comorbidities and the prescription of a higher number of drugs.  These serious DDIs can result in adverse clinical outcomes and should be avoided at all times.  This issue has been receiving increasing attention in the elderly population due to multiple medication use being more common in the management of diseases. Studies that have examined DDIs in hospital and outpatient settings, as well as drug registers, report DDI prevalence rates of up to 26%, whereas studies exploring DDIs in community-settings reveal a prevalence as high as 63%.  Prevalence rates in hospital settings are also varied, including wards, which have a rate of 57.8%, and emergency departments, which have a rate of 0.7%.

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Assisted living has become one of the primary providers of long-term residential care to the growing older adult population, especially elderly individuals with cognitive illnesses such as dementia.  According to statistics, close to one million adults reside in over 30,000 assisted living residences throughout the United States, with some housing more than 100 residents at a time.  Moreover, the use of health care resources is high among assisted living residents; an estimated 20% are Medicaid beneficiaries (although currently, only some states offer Medicaid support to assisted living residents); and recent statistics show that between 42 and 70% of residents are cognitively impaired, but only 13% of beds are designated for dementia special care units.  There are many concerns regarding the practices of prescribing medication for this patient population, and recent concerns have focused on the use of antipsychotic drugs to manage assisted living residents shoring dementia-based behaviors.

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Medical care in long-term care facilities, such as nursing homes, is a complex task due to the high number of dependent older adult residents with comorbidities varying in severity, polypharmacy, and psychological, physical, and neurosensory impairments.  Unfortunately, the management of chronic illnesses such as diabetes mellitus and the prevention of atherosclerotic issues are very rarely addresses in this vulnerable population.

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Research indicates that most falls experienced by older adults happen during the daytime and are often caused by slippery floors and irregular surfaces.  An estimated 20% of falls occur during the night and are most commonly experienced by the elderly, with about 30% experiencing a fall incidence once every year.  It is well known that when an older adult experiences a fall, their likelihood of getting injured, having a hip-fracture, and even dying are higher than those of younger adults.

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Hip fractures are highly prevalent in the ever-growing aging population due to age-related decline in bone strength. Not only do hip fractures cause extreme debilitation to quality of life, they also significantly increase the risk of mortality. The mortality rate one year after a hip fracture is an estimated 20%. Moreover, 20% of community-residing seniors who experience a hip fracture must be admitted to a nursing home. For those who are able to return to living in the community, most never fully regain the level of physical and social independence they previously had before hip fracture. Due to the devastating consequences that follow hip fracture, it is critical that risk factors are identified in order to prevent them from occurring.

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Making the decision to place a loved one in a nursing home or assisted living facility is a complex task. It is normal to fear the outcome of care for your loved one, especially regarding the use of medications and the possible abuse against the individual.

Antipsychotic drugs are a major concern in patients with Alzheimer’s Disease or dementia. Antipsychotic drugs are approved to treat serious mental illnesses, such as, schizophrenia and bipolar disorder, but are not regarded as a treatment for dementia.  Unfortunately, many dementia and Alzheimer’s Disease patients are given antipsychotic drugs to help reduce agitation, anxiety, and aggression, all emotions associated with dementia.

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The use of opioids in long-term care is prevalent.  According to a recent report, 65 percent of residents in nursing home care facilities in the US used opioids for pain.  A recent study investigated the opioid doses given to these residents due to their association with a variety of dose-dependent adverse drug events (ADEs), such as sedation, orthostatic hypotension, dizziness, cognitive impairment, constipation, and falls.  Older adults with dementia are particularly susceptible to opioid adverse drug events.  Currently, not much data exists on prescribed opioid doses in long-term care.

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