Polypharmacy is the use of several concomitant medications by one individual (Cantlay, Glyn, & Barton, 2016). The dilemma of polypharmacy in the elderly is an evolving phenomenon that needs to be addressed using specific literature. The elderly are more vulnerable to polypharmacy, but it can be experienced at any age. The inappropriate prescription leads to adverse drug effects and adverse drug events in the elderly combined with the comorbidities of the old. According to Watson & Pignone (2003), the physiology of healthy aging and pharmacokinetics, i.e., renal and hepatic metabolism, distribution volume) and pharmacodynamics (i.e., receptor site response) contribute to the overall harmful drug reactions that are observed in the aged. Most studies have reported that the adverse effects of medications are related to the number of drugs the patient is taking (Golchin, Frank, Vince, Isham, & Meropol, 2015).
This study will focus on eradicating polypharmacy by taking into consideration the physiology of aging and other ethical issues that may relate to the patient. The elderly will be defined as someone above or equal to the age of 65 years for the purpose of this study. The study will also review measures to eradicate polypharmacy in the elderly such as:
- Synchronizing drugs
- Simplifying medication schedule
- Minimizing PRN medications
- Accurate record of drugs at each office visit
- Patient education
- Prescribing slow release drug
- Utilizing pill boxes
This project will be a translational research and not research of discovery as multiple publications, but none are addressing all of the above using a simple tool on each office visit.
Below is a research project utilizing PICOt format:
P: Elderly at or above the age of 65 years
I: Prescription practice change: using a single agent to treat multiple conditions if possible
C: Traditional practice
O: Reducing polypharmacy in the elderly
t: In 12 weeks
DNP Project Preference Two
Breast Cancer Survival Rate in Black Women
Previous publications have concluded that black women have a higher mortality rate as compared to white women even when they are diagnosed at the same stage. The possible attributing factors to the racial survival difference include but not limited to socioeconomic factors, age, hormone receptor, and tumor differentiation/stage. Most of the studies had a P score < 0.001 of black women having higher histology and advanced disease than Caucasian women (Murthy, Krumholz, & Gross, 2004).
This project will evaluate the disparities in breast cancer survival rate and treatment between black and white women. Are these differences related to socioeconomic factors or biological factors? The project is to find a better outcome gearing towards a change in the treatment protocol for black women fighting cancer. This project will be a translational research.
P: Black women with breast cancer
I: Change in treatment approach versus access to health care
C: Current treatment approach
O: Increase the survival rate of black women with breast cancer
t: In 12 weeks
DNP Project Preference Three
The Relationship between Depression and Comorbidities in the Elderly
Clinically and epidemiologically, depression consistently affects the elderly, yet the contribution to this effect is not clear. Elderly patients with chronic comorbidities have a higher prevalence of major depression, which makes it harder to treat. According to Taylor, increased medical morbidity and major depression has a higher rate in post-critical care than primary care 5-10% in primary care whereas 37% after critical care hospitalization (2014).
In the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) uses a criterion for major depression that requires the presence of either sadness or anhedonia with a total of five or more symptoms over a two-week period (American Psychiatric Association, 2013). The prognosis for depression with coexisting chronic medical illness is reduced. This project will clarify why primary care providers underdiagnosed depression in the elderly who have chronic coexisting medical illnesses. The study will bring clarity amid the relationship of depression and chronic comorbidities in the elderly.
P: Elderly over the age of 60 years
C: Standard of Care
O: Early detection of depression in the elderly with comorbidities
t: In 12 weeks
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5). American Psychiatric Pub.
Cantlay, A., Glyn, T., & Barton, N. (2016). Polypharmacy in the elderly. InnovAiT, 9(2), 69-77.
Golchin, N., Frank, S. H., Vince, A., Isham, L., & Meropol, S. B. (2015). Polypharmacy in the elderly. Journal of research in pharmacy practice, 4(2), 85.
Murthy, V. H., Krumholz, H. M., & Gross, C. P. (2004). Participation in cancer clinical trials: race-, sex-, and age-based disparities. Jama, 291(22), 2720-2726.
Taylor, W. D. (2014). Depression in the elderly. New England journal of medicine, 371(13), 1228-1236.
Watson, L. C., & Pignone, M. P. (2003). Screening accuracy for late-life depression in primary care: a systematic review. Journal of Family Practice, 52(12), 956-956.
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