Polypharmacy Toolkit Initiative

The Polypharmacy Toolkit is a partnership of Nova Scotia’s district health authorities (DHAs) with assistance by the Nova Scotia Department of Health and Wellness (DHW). Coordination was provided through the Guysborough Antigonish Strait Health Authority (GASHA) and Cumberland Health Authority (CHA).

Initiative deliverables include: a toolkit to assist health care providers with managing medications for the frail elderly and continuing education around appropriate prescribing.

Addressing Polypharmacy with Frailty

Polypharmacy describes the administration of more drugs than are clinically indicated. This issue is of particular importance for older adults living in long-term care who commonly have multiple chronic illnesses. Twenty percent of Medicare beneficiaries have five or more chronic conditions and 50% receive five or more medications.1

The potential for adverse drug reactions increases as the number of prescribed medications accumulates and with age.2 The intersection of multiple chronic illnesses, multiple medications, age and frailty requires unique guidelines.

Older adults living in long-term care are frail. Frailty indicates vulnerability and typically manifests as a decline in function, mobility, and/or cognition. Frailty reduces life expectancy, increases the risk of adverse effects from medical treatment, and prolongs length of stay in hospital. These core characteristics of frailty will impact treatment outcomes and should be considered when making treatment decisions.

Studies on medication withdrawal in elderly patients show that up to 60% of medications can be successfully withdrawn without undesirable effects. In some cases, drug withdrawal improves cognition, decreases mortality and results in better quality of life. 3, 4, 5, 6

Despite these issues, the frail elderly are not often considered when it comes to developing guidelines, treatment protocols and practice standards. As clinical practice guidelines multiply, frail older adults frequently face the conundrum of too many medications and inappropriate treatments. Too often, the influential messaging of clinical practice guidelines overshadows more sensible approaches that would be pertinent for the frail.

For these reasons, the frail require their own treatment guidelines. To create frailty specific guidelines, several groups came together: the Palliative and Therapeutic Harmonization Program, the Dalhousie Academic Detailing Service, and the Diabetes Care Program of Nova Scotia. These groups, with the support of the district health authorities, worked together on a provincial initiative to develop a polypharmacy toolkit which will serve as a resource for healthcare practitioners.

Written by Laurie Mallery, Brian Steeves, Pam McLean-Veysey and Paige Moorhouse.


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