In planning interventions for an older frail patient with dementia who is admitted to a long-term care facility, which problem is considered priority?

In planning interventions for an older frail patient with dementia who is admitted to a long-term care facility, which problem is considered priority?

• A. Agitation
• B. Wandering behaviors
• C. Sleep disturbances
• D. Polypharmacy

Answer: (D)

Prioritizing reduction of medication burden is the main concept here. In a frail older adult with dementia, polypharmacy presents the greatest risk because multiple drugs raise the likelihood of adverse drug events, delirium, cognitive decline, sedation, and falls. Aging changes how drugs are processed mean medications linger longer and interact more, so the overall effect of many meds can worsen confusion and functional status. Focusing on a thorough medication review and deprescribing plan targets a root cause that can improve several problems at once, rather than adding therapies for each symptom. Start with a complete medication reconciliation, identify potentially inappropriate or redundant drugs (especially anticholinergics, benzodiazepines, and other sedatives), and adjust or discontinue as appropriate while ensuring necessary treatments remain. Employ nonpharmacologic approaches for agitation, sleep disturbances, and wandering as you optimize medications. By reducing the medication burden, safety and overall function in daily care are most likely to improve.

Prioritizing reduction of medication burden is the main concept here. In a frail older adult with dementia, polypharmacy presents the greatest risk because multiple drugs raise the likelihood of adverse drug events, delirium, cognitive decline, sedation, and falls. Aging changes how drugs are processed mean medications linger longer and interact more, so the overall effect of many meds can worsen confusion and functional status. Focusing on a thorough medication review and deprescribing plan targets a root cause that can improve several problems at once, rather than adding therapies for each symptom.

Start with a complete medication reconciliation, identify potentially inappropriate or redundant drugs (especially anticholinergics, benzodiazepines, and other sedatives), and adjust or discontinue as appropriate while ensuring necessary treatments remain. Employ nonpharmacologic approaches for agitation, sleep disturbances, and wandering as you optimize medications. By reducing the medication burden, safety and overall function in daily care are most likely to improve.