NURS 445 Week 4 Discussion Board Forum 3 Example

Discussion Board Forum 3: Polypharmacy and Deprescribing in Older Adults

NURS 445 Contemporary Issues in Nursing and Healthcare, Discussion Board Forum 3

Thread by [Student Name]

The patient and classmates are composites; the textbook and journal articles cited are real.

Mrs. L., 81, was admitted after falling in her bathroom at night. Her home medication list had fourteen items, including zolpidem for sleep, oxybutynin for an overactive bladder, two blood pressure medicines, a diuretic, a proton pump inhibitor and several supplements. She told me she got dizzy when she stood up and that she had been "a little foggy" for months. Her orthostatic blood pressures confirmed the dizziness: 142/80 lying down and 108/64 after standing for three minutes. No single prescriber had written all fourteen, and none of them had seen the full list; she saw a primary care physician, a cardiologist and a urologist, and each had added drugs over the years.

Mauk (2018) explains that age-related changes make older adults more vulnerable to adverse drug effects: a higher proportion of body fat, less body water, reduced liver metabolism and declining kidney function change how drugs are distributed and cleared, so doses that suit a younger adult can accumulate. Several of Mrs. L.'s medications are exactly the kind that worsen falls and confusion in older adults: a sedative-hypnotic, an anticholinergic and medicines that lower blood pressure on standing.

Deprescribing means planned, supervised reduction or discontinuation of medications whose harms outweigh their benefits. It sounds simple, but it rarely happens. Zhang et al. (2026) synthesized 52 qualitative studies of older adults with polypharmacy and the people around them and identified 18 barriers and 11 enablers, finding that deprescribing is a complex process depending on patient and caregiver engagement, communication between clinicians and patients and shared decision-making. Tuttle (2026) offers nurse practitioners a structured five-step framework that includes a comprehensive medication review, use of tools such as the Beers Criteria, realigning treatment with the patient's goals and safely substituting high-risk drugs, with the aim of making deprescribing a normal part of patient-centered care.

Bedside nurses have a real part in this even though we do not write orders. We can reconcile the medication list carefully on admission, including supplements. We can notice and document side effects such as orthostatic dizziness and confusion. We can raise concerns with the prescriber using specific findings, for example orthostatic blood pressure readings. And we can prepare patients for the conversation by asking what matters most to them. For Mrs. L., the team stopped the zolpidem with a tapering plan and replaced the oxybutynin. Before discharge, the pharmacist and I reviewed the new list with her and her son, wrote it in large print and asked her to bring every bottle to her primary care visit the following week. That last step matters most, because no one prescriber had the whole picture; the person who held all fourteen bottles was Mrs. L. herself. When I called her a week later for the discharge follow-up, she said she felt "clearer in the head" and had not felt dizzy getting up at night. Each prescription on Mrs. L.'s list made sense to someone; only together did they become dangerous.

Reply to Hannah

Hannah, your patient who refused to stop a sleeping pill she had taken for twenty years shows why Zhang et al. (2026) found patient engagement to be so central to deprescribing. For many older adults, a long-used medicine feels like part of their health, and stopping it can feel like losing care. Fear of withdrawal or of sleepless nights is real. One approach that respects her autonomy is to explain the specific risk in her own terms, such as falls at night, offer a slow taper rather than an abrupt stop and pair it with nonmedication sleep strategies such as consistent bedtimes and limiting daytime naps. Mauk (2018) also emphasizes involving older adults in decisions about their care, which means the decision may be hers even if we disagree. Would she be willing to try a small dose reduction for two weeks and then reassess together? Framing it as an experiment she can stop at any time may make it feel less like losing something.

Reply to Andre

Andre, you pointed out how many of your older patients have taken acid-reducing medicines for years without anyone remembering why. Tuttle (2026) highlights comprehensive medication review as the starting point of deprescribing, asking for each drug whether the original reason still applies and whether the drug still fits the patient's goals. Proton pump inhibitors are a good example, since they are often started for a short-term reason and continued indefinitely, and long-term use has been associated with potential harms in older adults. Raising the question with the prescriber, with the patient's history in hand, could start a review of whether the original reason still applies. Nurses can also teach patients not to stop these medicines suddenly, since symptoms can rebound. Has your unit considered flagging long-term acid reducers during admission medication reconciliation? A simple question on the reconciliation form, "Why was this started and when?", might prompt the review.

References

Mauk, K. L. (Ed.). (2018). Gerontological nursing: Competencies for care (4th ed.). Jones & Bartlett Learning.

Tuttle, J. L. (2026). The art and science of deprescribing: A practical guide for nurse practitioners. Journal of the American Association of Nurse Practitioners. Advance online publication. https://doi.org/10.1097/JXX.0000000000001359

Zhang, W., Ma, B., Jia, Y., Hou, Y., Zhang, M., Zhang, L., Liu, T., & Chen, O. (2026). Barriers and enablers to deprescribing from the perspectives of older adults with polypharmacy and their stakeholders: A systematic review of qualitative studies. International Journal of Nursing Studies, 184, 105701. https://doi.org/10.1016/j.ijnurstu.2026.105701