65. POLYPHARMACY AND BEHAVIOR CHANGE IN THE GERIATRIC PSYCHIATRY POPULATION: A CLINICAL CASE AND REVIEW

Introduction

According to recent data, seven in ten older adults had used at least one prescription drug in the past thirty days and one in five older adults had used at least five prescription drugs. These numbers indicate that polypharmacy is already prevalent, and with the number of prescriptions written and filled increasing, the number of patients taking multiple medications will also likely increase. Taking multiple medications increases the risk of adverse interactions and side effects, especially in the geriatric population. This issue was highlighted by a case in which psychiatry was consulted. The patient was an 80 year old female with a history of major depressive disorder with psychotic features who was admitted to the medicine service due to behavioral concerns and severe sleep disturbance in the setting of polypharmacy and recent onset of urinary retention and constipation in the weeks following a psychiatric hospitalization but prior to outpatient psychiatry follow up. The patient was prescribed nine oral medications total, four of which were psychotropic medications. Over the admission, her medical issues were addressed and some of her medications were tapered with the goal of discontinuing. This case inspired the following literature review and summary examining polypharmacy in elderly patients with psychiatric conditions.

Methods

A chart review of the hospital electronic medical record was completed for this clinical case. A literature search was performed in PubMed including publications in the last 5 years using terms such as “geriatric,” “psychiatry,” and “polypharmacy” and then further reviewed for relevance to search terms and topic and excluded if non-contributory. Studies examining polypharmacy without prescriptions of psychotropics were excluded.

Results

Results are presented in a table format organized by topic outlining findings, current recommendations, areas for improvement, and possible solutions to help mitigate polypharmacy practices.

Conclusions

Polypharmacy in the elderly continues to be a significant issue, and implementation of evidence-based recommendations will help mitigate the negative impacts of unnecessary polypharmacy on health and wellness of geriatric psychiatry patient populations. Areas for future study and intervention are discussed.