Medicated: Polypharmacy and Routine Care in the Aging Adult | myNEXUS®

14 . 10 . 2021

Polypharmacy in Aging Adults

It is predicted that the number of people aged 65 or older will grow from 524 million estimated in 2010, to 1.5 billion in 20501. As aging individuals seek therapy to maintain health and relieve ailments, treatment measures will include multiple prescriptions to treat various chronic and acute conditions. It is estimated that nearly one-third of all dispensed medications are prescribed to adults aged 65 or older2 and that older adults take an average of 8 medications daily3. There is an increased risk for deleterious effects related to the prescribed therapy as the number of medications increase.

Polypharmacy is a widely cited complication of treating medical conditions in aging patients. Some define polypharmacy based on the number of medications used. A commonly referenced definition is based on the use of 5 or more medications4. However, many individuals may appropriately require several medications to treat medical conditions such as:

  • hypertension
  • diabetes
  • heart disease
  • cancer

In such cases, the use of multiple medications for evidence-based treatment of complex or multiple conditions would be beneficial for some patients5. The problematic use of multiple medications occurs when they are inappropriately prescribed, or when the intended benefit of the medication is not understood5.

Potential Adverse Consequences of Polypharmacy

Polypharmacy is associated with several unfavorable consequences including increased medication costs, decreased medication compliance, and an increased risk for adverse drug effects6. Increased fall risk and a decline in functional status have also been associated with the use of multiple medications6. In some instances, older adults present with nonspecific symptoms including confusion, urinary incontinence, or weakness; these symptoms may not be directly viewed as drug-related but can be harmful to one’s quality of life. In some cases, however, these symptoms may indeed be related to polypharmacy7 and could be a result of treatment side effects or interactions with other medications.

Preventing Poor Outcomes

To avoid poor health outcomes from the use of multiple medications, it is important to ensure that all medications used have an appropriate benefit. There are a few tools that have been developed to aid the healthcare provider in identifying problematic polypharmacy. Some tools suggest ensuring that there is an appropriate diagnosis for the prescribed drug, the dosing and instructions are correct, there are no duplications of therapy, and that potential drug-drug or drug-disease interactions have been considered7.

To consider and identify potential harms related to prescribed medications, it is important that the aging individual maintain a complete medication list, and periodically review this list with all healthcare providers during any encounter. As patients with multiple comorbidities will likely be treated by multiple providers for primary and secondary care, it is likely that each provider that is prescribing therapy will not be aware of every drug that a patient is taking. It is also likely that prescribers may be unaware of over-the-counter drugs used, as some patients may self-medicate to seek relief from specific illnesses.

Maintaining an accurate and updated list of all medications may aid prescribing providers in identifying potential adverse effects as a treatment plan is considered. This can also help to identify medications that may no longer have the benefit to the patient’s condition and can be discontinued to simplify care.  These efforts will serve to lower the risk for additional office visits, emergency department presentations, and hospitalizations to manage harmful complications of polypharmacy, which can increase healthcare costs and challenge the effective delivery of quality healthcare.

Help Maintain Medication Safety

While there is a proposed benefit to all therapies considered for any patient, it is important to ensure that the overall treatment goal remains to improve the health and quality of life of the individual. This can be facilitated by those, directly and indirectly, involved in the delivery of care. If you identify potential medication-related complications for an individual, make sure to report your concerns to the prescriber and the patient. Check out our blog for more educational topics like this and much more.

SOURCES:
  1. World Health Organization. Global health and ageing. Geneva: 2011. http://www.who.int/ageing/publications/global_health.pdf
  2. Vincent, G. K., & Velkoff, V. A. (2010). The next four decades, the older population in the United States: 2010 to 2050. In Current population reports, 25-1138. Washington, DC: U.S. Census Bureau.
  3. Hayes, B. D., Klein-Schwartz, W., & Barrueto, F., Jr. (2007). Polypharmacy and the geriatric patient. Clinics Geriatric Medicine, 23(2), 371-390
  4. Rankin A, Cadogan CA, Patterson SM, et al. Interventions to improve the appropriate use of polypharmacy for older people. Cochrane Database Syst Rev. 2018;(9):CD008165.
  5. The King’s Fund. Polypharmacy and medicines optimization: making it safe and sound. London, 2013.
  6. Maher RL, Hanlon J, Hajjar ER. Clinical consequences of polypharmacy in elderly. Expert Opin Drug Saf. 2014 Jan;13(1):57-65.
  7. Riker, Gretchen I. PharmD; Setter, Stephen M. PharmD, CDE, CGP Polypharmacy in Older Adults at Home, Home Healthcare Nurse: September 2012 - Volume 30 - Issue 8 - p 474-485