Analysis of Poly-pharmacy Effects on Elderly in UK Care Settings

This report delves into the critical issue of poly-pharmacy and its effects on the elderly within UK care settings. The introduction defines poly-pharmacy and highlights its association with adverse medical outcomes, increased healthcare costs, and potential drug interactions. The literature review examines the concept of poly-pharmacy, evaluating its essentialities and impact, while also exploring strategies to mitigate its negative effects. The research methodology outlines the philosophical aspects, data collection methods, sources, inclusion/exclusion criteria, and ethical considerations. The findings, discussion, and conclusion synthesize the research, analyzing the consequences of poly-pharmacy, and the importance of understanding its complexities to improve the healthcare outcomes for older adults. The report emphasizes the need for strategies to reduce the negative impact of poly-pharmacy, which includes the risk of adverse drug reactions, and the enhancement of healthcare costs. This report is valuable for students looking to understand the impact of poly-pharmacy on the elderly, and it is available on Desklib, a platform that provides AI-based study tools for students.

HEALTH AND SOCIAL
CARE

Table of Contents
TITLE..............................................................................................................................................1
CHAPTER 1: INTRODUCTION....................................................................................................1
Introduction to chapter...........................................................................................................1
Background to problem..........................................................................................................1
Aims.......................................................................................................................................2
Objective.................................................................................................................................3
Research questions.................................................................................................................3
CHAPTER 2: LITERATURE REVIEW.........................................................................................3
Concept of poly-pharmacy for the elderly living in the UK care settings..............................3
Evaluate the essentialities and impact of poly-pharmacy for the elderly living in the UK care
settings....................................................................................................................................5
Examine the ways and strategies used to reduce the negative impact or effect of poly-
pharmacy for the elderly living in the UK care settings.........................................................6
CHAPTER 3: RESEARCH METHODOLOGY (2000)..................................................................8
3.1. Philosophical aspects of the research..............................................................................9
3.2 Data collection method (gives the methods used to find literature).................................9
3.3 Data sources (gives the places e.g. journals, etc. where the literature was found).........10
3.4 Inclusion and exclusion criteria......................................................................................11
3.5 Data analysis (gives how the literature was analysed)...................................................11
3.6 Research ethics (gives how ethical concerns were addressed in your research)............12
3.7 Limitations of the research (problems encountered and how you dealt with them)......13
3.8 Summary of the chapter (gives what has been presented in the chapter).......................14
CHAPTER 4: RESULT.................................................................................................................14
CHAPTER 5: FINDING, DISCUSSION, AND CONCLUSION.................................................17
REFERENCES..............................................................................................................................20

TITLE
“Effects of poly-pharmacy for the elderly living in the UK care settings”
CHAPTER 1: INTRODUCTION
Introduction to chapter
Poly-pharmacy is defined as the regular use of at least five medications in a day. It is
usually common among the elder people and the young people in the risk population and
enhances the risk of the adverse medical outcome. There are various risks determined that can
lead to developing poly-pharmacy (Gomes et. al., 2020). It may also include some drug which is
associated with the over-the-counter, prescription and traditional and mandatory medicine that is
generally used by elder patient. In addition to this, the discussion is related to the effect or impact
of poly-pharmacy in elder people within the UK healthcare setting (Dhakal et. al., 2020). The
research has provided the data on the consequence due of the poly-pharmacy and the discussion
carries the ways and strategies which are used to eradicate the consequence which may create or
formulate the negative impact (Rieckert et. al., 2020).
Background to problem
In the context of the research aim or title, the major issue or problem which is determined
is the negative consequence that is well associated with poly-pharmacy. In addition, the burden
of taking multiple medications has been well associated with the enhancement in healthcare costs
and shows the risk of adverse drug events, drug interaction and medication with the non-
adherence, reduce functional ability, and many more (Siddiqua, Abdullah, and Kareem, 2019).
Poly-pharmacy is an area of concern that refers to regular utilization of at least five medications,
and it is generally among older adults and younger who are risk populations and inclination risk
of adverse medical results. Several risk factors lead to poly-pharmacy.
Poly-pharmacy is considered the region of concern for the elderly as this has several
factors and reasons. Elderly people are at higher risk for adverse drug reactions (ADRs) as of
metabolic alteration and reduced drug clearance which is linked with the aging of individuals.
This risk is further worsened by inclining the number of drugs that are used. The potential of
drug-drug interactions is further inclined by the utilization of multiple drugs (Gomes et. al.,
2020). When a case-control study was carried out among elderly people, poly-pharmacy was
found to be an autonomous and major risk factor for causing hip fractures.
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Possible symptoms of poly-pharmacy are unfortunately usually disturbed with the normal
signs of aging such as tiredness, sleepiness, or any degraded alertness, constipation, and related
diarrhoea. Other signs may include inconsistency, loss of appetite, dilemmas in actions,
depressive thoughts or lack of interest in general activities, weakness in the body, tremors,
visualizations or related auditory hallucinations with inclined anxiety, and dizziness within
elderly people very common. Poly-pharmacy can also lead to adverse drug reactions, which are
mostly caused due to OTC medications. The most consonant risk component for adverse drug
reactions is considered the number of drugs that are taken by elderly people because the number
of drugs that are taken inclines and the risk of adverse drug reaction also inclines steadily.
In older adults, prescribing three or more of these types of drugs which are known as
central nervous system (CNS) active poly-pharmacy can lead to an increase in falling risks,
relative overdoses, memory-related issues, and deaths. The study is based on data and
information from 1.2 million people who are suffering from dementia. Patients and health care
providers are commonly looking over for more common symptoms of adverse drug reactions and
their related interactions which ultimately results in poly-pharmacy. The danger that is associated
with each cause of poly-pharmacy is a chronic illness in elderly people and most older adults
generally suffer from one chronic condition.
Multiple renders also disturb their drug responses and related connections, poor
medication can cause severe health-related issues, and common side effects comprise sedation,
nephrotoxicity, hepatotoxicity, cardio-toxicity, and dilemma and confusion. Patients are more
comprised with dizziness, related hypotension, and hypoglycemia. Poly-pharmacy has negative
consequences and inclining utilization of multiple medications is associated with any health-
related risk and greater healthcare costs to the patients. This defect has many other potential
negative impacts and effects that include reduced adherence and relative adverse drug events.
Older adults or elderly people with multiple subspecialist medical practitioners and no primary
care physician are in particular at risk of poly-pharmacy (Rieckert et. al., 2020).
Aims
To analyse the effect of the Effects of poly-pharmacy on the elderly living in the UK care
settings.
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Objective
 To understand the concept of poly-pharmacy for the elderly living in the UK care
settings.
 To evaluate the essentialities and impact of poly-pharmacy for the elderly living in the
UK care settings.
 To examine the ways and strategies used to reduce the negative impact or effect of poly-
pharmacy for the elderly living in the UK care settings.
Research questions
 What is the concept of poly-pharmacy for the elderly living in the UK care settings?
 What are the essentialities and impact of poly-pharmacy for the elderly living in the UK
care settings?
 What are the ways and strategies used to reduce the negative impact or effect of poly-
pharmacy for the elderly living in the UK care settings?
CHAPTER 2: LITERATURE REVIEW
Concept of poly-pharmacy for the elderly living in the UK care settings.
As per the view of Laurie E Davies and et. al., (2020), concept of poly-pharmacy is
widely being addressed among older people, but the adverse outcomes accompanied with it are
unclear. The review aims to synthesize current evidence for effect of poly-pharmacy utilization
in older people. Poly-pharmacy is referred to the condition in which multiple number of
medications are prescribed to an individual. In simple words, it is explained as the concomitant
use of 5 or more medicines. Poly-pharmacy is being common within older people, because of the
increases level of multi-morbidity which occur due to population ageing and due to lake of
evidences for supporting de-prescribing approaches.
Intake of 10 or more medicines by old age people is referred as hyper poly pharmacy.
Poly-pharmacy in older people may be suitable but it is also having negative effects. These
negative effects include drug adherence, adverse drug events, utilization of health care, and
cognitive impairment. The review utilized a number of groups for examination of adverse
outcomes related with poly-pharmacy. Poly-pharmacy is likely to create more adverse effects in
older people, especially when integrated with functional decline. Elder people are generally at
higher risk for developing adverse drug reaction due to their metabolic changes. These risks are
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furthermore exacerbated by increasing the number of medicines. Older people who are in long-
term care installation are at higher risk of developing adverse drug effects and are more decrepit
than the community-dwelling population. The review identifies the evidence for the related in
between poly-pharmacy and adverse outcomes which include adverse drug reactions, disability
and adverse drug events.
The review further explained that adverse effects of poly-pharmacy has been the reason
of conflict as few reviews relate it with number of medication and few related it with co-
morbidities. It was found that poly-pharmacy in very old people (aged more or equal to 85 years)
need more research for evaluating potential social consequences which are associated with it.
According to the article reviewed, among the large population of older people, 80% have age
≥55 years, the adverse outcomes in this age group consist of adverse health, social, medicine
management, and health care utilization of poly-pharmacy. The evidence for the adverse health
outcomes related with poly-pharmacy showed that positive associations among both were found
for frailty, malnutrition’s, and selected chronic disease areas. In simple words, these disease
conditions are possibly having association with poly pharmacy. The evidences for the adverse
drug reactions, adverse drug events, depression, falls, fractures, weight loss, disability, and
morality were conflicting as per the review.
Medicine management is explained as the effective and safe use of medicine by the
patients and the NHS is used for the prescribing, administration as well as for dispensing the
medicaments. Poly-pharmacy also include, adverse use of health care and their interlinked
outcomes. These outcomes consider unplanned administration, hospitalization, and numbers of
prescribers. In the context of this article, the conflicting evidence for the association between
poly-pharmacy and a range of adverse outcomes consider adverse drug events, adverse drug
reactions as well as disability. There are so many operational poly pharmacies as medical count
and those that are specifically aimed at the poly pharmacy (Mangin et. al., 2018).
The research explores the harms of poly-pharmacy in very old people that are aged≥ 85
years and potential social consequences which are inter-connected with it. There are so many
consequences associated with poly-pharmacy which include its symptoms and diseases. Effects
of poly-pharmacy are described by the prevalence of various conditions in later life and with the
prescribing patterns. The evidence gap for the adverse cultural outcomes of poly-pharmacy can
be explained by the limited primary research in the area. Poly-pharmacy among residents of aged
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care facilities with anxiety may be due to anxiolytic and hypnotic prescribing. The article refers
that, examining the adverse outcomes of poly-pharmacy in older persons is complex, extensive,
and conflicting and future work should look for operational poly-pharmacy in a more clinical and
relevant manner. The review further explains that there is a need of research for evaluating the
prescribing decisions which have impact over the health of older people.
Evaluate the essentialities and impact of poly-pharmacy for the elderly living in the UK care
settings.
World health organization provides data that in every nine people one fall in the category
of elder about age 60 years (Mangin et. al., 2018). The global data considers adverse outcomes to
be associated with income of countries rather than age. As ageing is not a concern for high-
income countries. Whereas, the majority of the older people are living in low and middle-income
countries and are facing multiple morbidities (Tan, Suppiah, Bautista, and Malhotra, 2019). The
ageing is accompanied with decreased immune system and multiple chronic diseases such as
hypertension, diabetes mellitus, arthritis, chronic heart disease, renal disease, etc., These disease
states and deceased health conditions compelled old age group to take multiple medicaments,
this is referred as poly-pharmacy. Various global studies have shown that on average, 2 to 9
medications per day are taken by elder people (Ersoy, and Engin, 2018).
According to Zhang et. al., 2012, poly-pharmacy is described as taking several medications
in a single dose like “taking five or more medications concurrently”. Poly-pharmacy is mostly
identified in old age people with several chronic diseases. In the UK, majority of older adults are
suffering from a range of chronic diseases therefore, to manage these multiple chronic situations
multiple medicaments are required. In this scenario, poly-pharmacy shows its essentialism in
older adults.
According to the perspective of Giuseppe Sergi and et. al., (2011), the main causes of poly-
pharmacy are co-morbidities, longer life expectancy, and the implementation of proof-based
clinical practice guidelines, which shows its essentialist in precaution as well as the treatment.
Beside that poly-pharmacy also shows vital negative consequences like the higher risk of drug-
drug interaction and adverse drug reactions which further results into decreased efficacy of
medication due to decreased compliance of patient. In UK, older care setting factors which are
related with excessive poly-pharmacy, are the following: (1) Elder people are suffering from
chronic diseases in comparison to other generation groups. (2) Older adults have a long-lasting
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illness. (3) Handicap conditions. (4) self-reported depression condition. (5) longer life
expectancy and so on. These factors are the reason for initiating poly-pharmacy in older age
groups.
As per the view of Rushabh J Dagli and Akanksha Sharma, (2014), Poly-pharmacy is a
greater global risk factor for older adults. It is an area of concern for older age people, due to its
majority of negative impacts. Such negative impacts include, adverse drug reactions and drug
interactions. The reason for negative impacts of poly-pharmacy in old people are associated with
metabolic changes and decreased drug clearance in older age people. In addition, these risks are
becoming worse with increased number of medicaments. In Older care settings, poly-pharmacy
increases the risk of overdose, memory issues, falls, and death. According to the statistic, in UK,
there are more than 1.2 million people with dementia who are using medicaments in a single
period. Apart from the adverse drug reactions, poly-pharmacy have additional negative effects,
which are drug-disease interaction, cognitive impairment, hospital admission, non-adherence,
and mortality.
Pharmacokinetics of few drugs are different and because of which, poly-pharmacy
naturally enhances the chances of adverse drug reactions (ADRs). Approximately, 19-21% of
hospital occupancy in UK are covered by older people suffering from ADRs, due to their
frequent underestimation. Poly-pharmacy also contributes for enhancing the health care costs for
both healthcare administrations and the patient. Poly-pharmacy has shown an increment by 30%
within the medical costs. It is also responsible for the functional declination in older age people
of UK health care settings. Some other risk factors which are associated with poly-pharmacy
include frailty, obesity, lowering mental and physical health status, and multi-morbidity. These
health-related issues are related with the use of excessive amounts of drugs in a single period
(Dhakal, and et. al., 2020). Poly-pharmacy in old age people are initiated due to their
essentialism but on prolong use, these are responsible to produce some adverse effects. Older
people are effected mostly due to their decreased immunity and metabolism along with other
health co-morbidities, which are elaborated in the review.
Examine the ways and strategies used to reduce the negative impact or effect of poly-pharmacy
for the elderly living in the UK care settings.
From the perspective of Lori Malone, (2021), Poly-pharmacy is referred for using more than
five medications at once, with ten or more ten it is known as severe. Poly-pharmacy is more
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common in the geriatric age population due to their sufferings from multiple chronic or acute
disease, which require more than one medication for their treatment. General practitioners are
advised to be more careful with geriatric patient regarding the prescription of multiple
medicaments. Practitioners should evaluate the problems related to poly-pharmacy and should
identify its impact on health of patient (Ellett, and et. al., 2018). In UK, there is a proof of
disease-specific management, but there are no guidelines on multiple medicines prescription for
people who are suffering from multiple health conditions. Therefore, the serious clinical problem
associated with poly-pharmacy are emerging at peak which needs identification and strategic
development (Sukumar, and et. al., 2022).
`There are several steps, taken in order to reduce the negative impacts of poly-pharmacy
within the older age people, living in the UK care settings. These are: (1) work carefully with
patients and families of patients for securing an appropriate list of medication, getting an
appropriate list of medications can be more challenging for the patient. They had to work hard in
order to find out all the medication which are taken by patients along with its time and route.
Patients several times have some creative ideas for remembering how many medications to take,
like a patient making a sign of X on the sticker of the bottles or strip of medicine for each tablet
they are required to administer in a day. Knowing all the drugs which are prescribed by
practitioners and filled by physicians is significant, but so is knowing its system. There is also a
requirement of understanding the need of change within the medicaments as these are changed,
in order to enhance safety and compliance (Gutiérrez-Valencia, and et. al., 2019). Therefore, to
overcome the impact of poly-pharmacy, more than one member is required from families or care
setting teams to manage medication properly for the older people in UK care settings.
(2) Identify the list of medications in an Electronic Health Record (EHR) of the patient. In
UK older people's care setting, EHR are used for track of medications of patients. when any
medication is written into an EHR of the patient, it generally appears in alphabetical sequence,
but very few suggest grouping medications via the condition or use in place of this. The carer
needs to identify the EHR list by category of drug prescribed to elder people, for example
anticholinergic, antidepressant, pain control, blood pressure, chest pain, and so on. This type of
grouping of medications permit to quickly find out the condition where one medication is used
for treatment of two or more conditions (Ross, and Gillett, 2021). Remove the medication from
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prescription which could be interacting with another medication or foods and causing various
health issues.
(3) look for inappropriate and incorrect medications, sometimes poly-pharmacy issues are
simply due to the inappropriate medications which are prescribed for a specific disease
condition. Absence or inadequate health literacy also accounts for inappropriate and incorrect
medication use. Sometimes, patients take two medications for a similar disease condition on the
prescription of practitioners, which may cause poly-pharmacy (Hashimoto, and et. al., 2020). In
UK, carer of older people's care settings should evaluate these conditions frequently and should
try to reduce the situation of poly-pharmacy. Through these methods or strategies, the negative
impact of poly-pharmacy in older people can be reduced significantly. These strategies can be
emerging as the beneficial tool for minimising death rate due to poly-pharmacy in old age
people.
Additionally, the tools which can be proved as beneficial in reducing effect of poly-
pharmacy in old age people include: (1) De-prescribing: it is the most effective way to decrease
poly-pharmacy. (2) Medication appropriateness index: it is the set of ten questions that assists
the clinician to prescribe the drugs (Kouladjian O'Donnell, and et. al., 2021). (3) Beers criteria: It
helped physicians to make smarter decisions for prescribing only appropriate medicines and also
assisted to decrease adverse drug reactions. (4) Start criteria: it is the screening technique to alert
to appropriate treatment, that is START. (5) Stop criteria: it is the screening techniques of
prescriptions especially for older people, that is STOP. (6) ARMOR: Through Assess, Review,
Minimize, Optimize, and Reassess, protocols give a stepwise viewpoint for analysing poly-
pharmacy in old age patients living in UK care settings. (7) good Palliative-Geriatric practice
algorithm: through these practices, algorithm carers in the UK care setting reduce the negative
impact of poly-pharmacy in their older patient (Ishizaki, and et. al., 2020).
CHAPTER 3: RESEARCH METHODOLOGY (2000)
It forms out a crucial part of every investigation that includes a systematic process that helps
in having effective data collection through making use of the various set of the techniques.
Beside this, the research methodology section also tends to provide the blueprint and effective set
of frameworks that supports significance and authentication of the overall study. Along with this,
the selection and choosing of the research methods are tend to be made by the researcher on the
basis of type of study as well as the nature of the topic on which the investigation is being
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performed by the researcher. Further, the selection of the research method and philosophy is also
tending to be based on the convictions, beliefs as well as the interest level of researcher that leads
and brings a higher efficiency and authenticity in data collection process. The analysis of the
research method and philosophy that are being used and applied within current study are
presented and discussed as below:
3.1. Philosophical aspects of the research
Philosophical aspects can be described as a framework which helps in guiding how
research can be conducted on the basis of ideas regarding reality as well as nature of required
knowledge. It helps in determining the driving purpose in context to education and the roles of
varied participants. There are four aspects which are undertaken by researchers for determining
the research methodology in an effective manner such as pragmatism, positivism, realism and
interpretivism. Pragmatism philosophical aspect is concerned with acceptance of practical
consequences while rejects ideas which are unpractical in their approach. Positivism
philosophical aspect is essentially concerned with a state under which researcher is certain and
confident about their choice of ideas. Realism concept is termed as a viewpoint which principally
accords objects or things has a specified mind-independent reality.
Interpretivism is a philosophical concept which states that reality is subjective as well as
a composite of multiple perspectives. In this specified research, researcher has used
interpretivism aspect which help them in registering the valid responses. This research
philosophy is taken into account in this research as it delves a knowledge of interpreting social
world in regards with subjective manner. Through using this researcher can interpret social
reality on the basis of their subjective viewpoints in order to make secondary research effective.
The justification behind using Interpretivists is that it prefers qualitative data in order to remove
the chances of biases and vague facts from the research. With the aid of prescribed approach,
interests of human can also be developed in regards with specified research. In addition to this,
another reasoning for using the interpretivism philosophy is that it provides valid results which
are nearer to the truth.
3.2 Data collection method (gives the methods used to find literature)
Data Collection can be understood as a systematic approach which is used by researchers
for collecting information and relevant facts from reliable sources in order to evaluate an
outcome in a strategic manner. Primary methods of research comprise of varied techniques such
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as questionnaire, surveys, interviews and many more. Secondary research essentially involves
summary, collation as well as synthesis in regards with existing research. Secondary research is
conducted through collection as well as analysis of data through organisational reports, internet,
archives and many more. Secondary research helps in gaining critical insights regarding market
size, latest trends, changing dynamics and competitors.
In this particular research, secondary research is taken into consideration as it is cost-
effective alternative for researchers. Collection of secondary data is not a tough job and implies
time-saving accessibility as credible websites and journals can be assessed with the aid of
internet. In this research, credible sources are searched in order to gain insights for relevant
literature in an effective manner. The justification behind using secondary research is that it helps
build on existing knowledge about the topic to reach the specific conclusion. It is justified
method of data collection for this investigation for this research because secondary research can
be completed quickly and with less expenses.
3.3 Data sources (gives the places e.g. journals, etc. where the literature was found)
The current study is based on the secondary sources of data thus the data sources that are
being used within current study includes of already collected sets of data that are available in
form of exiting literature on various online sites such as google scholars, Microsoft Academic,
Wolfram Alpha, etc. Further, the data sources for current study tend to includes and comprises of
the online set of the journal, articles, books and other form of literature. Use of reports along
with health statistics, medical records, peer reviewed literature, etc. has been also made within
current study as data sources to have selection and use of authentic as well as most suitable set of
the data. The use of the journals and articles are seemed to be most suitable as data sources as
they provide a rich source of information based on some previous study and investigation thus
supports better understanding and information about the selected topic.
For conducting this research, varied credible sources are searched for finding the relevant
literature and facts such as Google Scholar, Microsoft Academic, Wolfram Alpha and many
more. Secondary research is considered as effective as it aids in making primary data collection
specific and curbing gaps as well as deficiencies in research in a strategic manner. Chosen
literature in respect to this research help researcher in understanding as well as knowledge of
their desired subject. Using literature is considered as efficient as it provides authenticity to the
research in an effective manner. The justification behind using wide variety of data collection is
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