NCLIP

Geriatric Assessment and Polypharmacy Safety

3 min read

Geriatric Assessment and Polypharmacy Safety

Key Points

  • Comprehensive geriatric assessment (CGA) integrates function, cognition, mood, nutrition, pain, and social context.
  • Polypharmacy increases risk for interactions, delirium, falls, organ toxicity, and adherence failure.
  • Functional screening must be paired with active follow-up, not documentation alone.
  • Elder-abuse surveillance is a nursing safety responsibility in all care settings.

Pathophysiology

Older adults often receive multiple concurrent therapies for multimorbidity. Age-related pharmacokinetic and pharmacodynamic changes can convert otherwise standard regimens into high-risk combinations, especially when sedation, orthostasis, anticholinergic effects, or renal-hepatic burden accumulate.

CGA improves outcomes by identifying interacting vulnerabilities early: cognitive impairment, mobility decline, nutritional imbalance, mood symptoms, abuse risk, and caregiver strain. Early correction prevents avoidable hospitalization and functional collapse.

Classification

  • CGA domain set: ADLs/IADLs, cognition, mood, pain, nutrition, falls, social supports, and advance preferences.
  • Medication-risk domain: Drug-drug interactions, duplicate therapy, high-risk classes, and adherence burden.
  • Safety domain: Fall risk, home/environment hazards, and supervision mismatch.
  • Abuse-surveillance domain: Physical, psychological, neglect, and financial exploitation indicators.

Nursing Assessment

NCLEX Focus

Questions often test the safest next action when confusion, falls, and new medications occur together.

  • Assess complete medication list including OTC vitamins, supplements, and herbal products.
  • Assess for potentially inappropriate medications using evidence-based geriatric safety criteria.
  • Assess functional status trends with standardized ADL, cognition, and depression tools.
  • Assess for abuse/neglect indicators and inconsistent injury patterns requiring escalation.
  • Assess caregiver capacity, education needs, and respite-resource access.

Nursing Interventions

  • Lead CGA workflow with interdisciplinary coordination and documented follow-through.
  • Escalate polypharmacy concerns to prescriber-pharmacist review and deprescribing discussion when appropriate.
  • Implement individualized fall and medication-adherence safety plans.
  • Use validated elder-abuse screening pathways and mandated reporting procedures per policy.

Hidden Medication Risk

Unreviewed supplement use plus multiple prescriptions can create serious interactions despite “natural” product labeling.

Pharmacology

High-risk classes in older adults include benzodiazepines, sedative-hypnotics, anticholinergics, and interacting multi-drug combinations; nursing surveillance should prioritize cognition, gait safety, renal-hepatic burden, and real-world adherence.

Clinical Judgment Application

Clinical Scenario

An 82-year-old with recurrent falls uses seven prescriptions plus sleep supplements and reports new daytime confusion.

Recognize Cues: Polypharmacy with new cognitive and safety decline. Analyze Cues: Interaction burden and sedative effects are likely contributors. Prioritize Hypotheses: Immediate priority is preventing additional injury and evaluating medication-related delirium risk. Generate Solutions: Start CGA, perform medication reconciliation, and request pharmacist-prescriber review. Take Action: Implement fall precautions and targeted deprescribing/safety plan. Evaluate Outcomes: Reduced confusion episodes, fewer falls, and safer medication routine.

Self-Check

  1. Which CGA components are most important after a new fall with confusion?
  2. Why should supplement review be mandatory in older-adult medication reconciliation?
  3. What findings should trigger immediate elder-abuse escalation?

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