Date of Award

Spring 3-12-2024

Document Type

Scholarly Project

Degree Name

Doctor of Nursing Practice (DNP)

First Advisor

Dr. Sheri Jacobson

Second Advisor

Dr. Nichole Lawson

Abstract

Practice Problem

The rising prevalence of chronic health conditions, the aging of the population, and advances in healthcare technology have contributed to the rampant over-prescribing of medications and the prescribing of potentially inappropriate medicines (PIMS) in community-dwelling older adults. Additionally, reluctance by the medical community to deprescribe and resistance among patients and their caregivers due to misperceptions about withdrawing treatment has further perpetuated the problem.

PICOT

The PICOT question for this project was, in community-dwelling older adults over age 60 receiving palliative care, does the implementation of an interprofessional deprescribing intervention compared to standard care by a home-based medical care program improve quality of life over a 10-week period?

Evidence

The literature clearly demonstrates that polypharmacy and PIMs have been associated with adverse drug events, including drug interactions and side effects, falls, hospitalizations, low quality of life, and increased healthcare costs. The evidence also shows that deprescribing interventions have improved health outcomes among this population.

Intervention

One market was chosen to implement an interprofessional deprescribing intervention involving pharmacists and advanced practice providers. The number of medications taken and quality of life scores were measured pre- and post-intervention. Of the 41 medication reviews completed, there were 78 deprescribing recommendations.

Outcome

Unfortunately, due to numerous barriers and limitations, only two medications were deprescribed throughout the pilot; therefore, the post-intervention quality of life scores could not be measured. The pre-intervention quality of life scores were low compared to the general population.

Conclusion

This DNP project exemplifies the magnitude of the problem of polypharmacy in older adults with palliative care needs and the burden of overcoming the challenges of deprescribing experienced providers. Collective efforts of a multidisciplinary team offer the best chance of successful deprescribing of PIMs and improving outcomes for community-dwelling older adults with serious illness.

Comments

Scholarly project submitted to the University of St. Augustine for Health Sciences in partial fulfillment of the requirements for the degree of Doctor of Nursing Practice.

Creative Commons License

Creative Commons Attribution 4.0 License
This work is licensed under a Creative Commons Attribution 4.0 License.

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