Helping the Elderly to Stay Safe from Polypharmacy

Table of Contents

Summary

Polypharmacy is a medication safety issue that becomes more and more disturbing among old-aged patients. Most commonly polypharmacy can be avoided by excluding the medications a patient, in fact, does not need. If all drugs indeed are necessary, the intake of them should be strictly controlled by a case manager.

The definition of polypharmacy

Polypharmacy was defined in a lot of different ways, but still, there is no one general definition. This term refers to the intake of several medications, more precisely at least five of them at the same time. Although nine times out of ten a patient does not need all of those drugs, polypharmacy and inappropriate use of medications are not the same. To conclude, polypharmacy is an excessive intake of drugs, some of which can be, but not always are, unnecessary.

In the United States, this term is often associated with an absence of indication while Europeans usually relate it to a number of drugs.

The reasons that lead to polypharmacy

The etiology of polypharmacy can be different. First of all, the necessity of multiple medications can be caused by chronic medical conditions, and people with hypertension or diabetes are prime examples of that (Fulton & Allen, 2005). These patients have no other choice, but to hourly take their medications, and in case of other illnesses they will need a few drugs more.

Another common reason for polypharmacy is self-medication. Besides, frequently patients are negligent about the regimen and duration of their treatment. In that case, they continue taking their medications, although they do not need them anymore.

Consulting different physicians and getting several prescriptions can also become the cause. The drugs often have analogs, and sometimes patients even do not realize that they are taking two very similar medications. Finally, a variety of drugs in the market, the presence of too many herbal and over-the-counter (OTC) preparations and the tendency to take medications advised by friends are also the risk factors.

Why polypharmacy is risky?

All of the reasons mentioned above most frequently happen among the elderly, and in addition to age-related problems they often have, the consequences of taking multiple medications can be rather disturbing.

There are two main dangers related to polypharmacy, unfavorable drug interactions and an increased risk of side effects. Furthermore, if side effects occur, it will be hard to determine, which one of the multiple drugs has become the reason. While the risk of adverse effects of two medications is only 13%, for five different drugs it increases to 58% (Prybys Melville, Hanna, Gee, & Chyka, 2002). In the case of more than six drugs, the probability of side effects is 82% (Prybys et al., 2002).

Finally, patients who take multiple drugs have low morbidity and mortality rates (Eyigor & Kutsal, 2012).

Precautionary measures

To avoid both side effects and additional diseases caused by polypharmacy, the intake of multiple drugs should be strictly controlled by patients’ case managers. Primarily, it should be checked whether all of the medications a patient takes are necessary. If there is more than five of them and some OTC drugs are on the list, they should be excluded. The next step is to consult a patient’s physician to find out if the prescribed medications can be combined. It can help to prevent dangerous drug interactions. Finally, a case manager should make a detailed schedule for a patient to know when and how every drug should be taken.

Following these simple rules, case managers can prevent the undesirable consequences of polypharmacy and greatly simplify patients’ lives.

References

Eyigor, S., & Kutsal, Y. G. (2012). Polypharmacy in the elderly: to prescribe, or not prescribe “that is the question”. Turkish Journal of Geriatrics, 15(4), 445-454.

Fulton, M. M., & Allen, E. R. (2005). Polypharmacy in the elderly: a literature review. Journal of the American Academy of Nurse Practitioners, 17(4), 123-32.

Prybys, K. M., Melville, K., Hanna, J., Gee, A., & Chyka, P. (2002). Polypharmacy in the elderly: clinical challenges in emergency practice: part 1 overview, etiology, and drug interactions. Emergency Medicine Reports, 23(11), 145-153.

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