Polypharmacy in the Elderly

If you are over the age of 65, it’s likely you’re on more than one medication. Polypharmacy in the elderly—the use of multiple medications, typically five or more—is becoming more and more common.

One survey of 2,206 community-dwelling older adults showed 87% were taking a prescribed medication, and over one-third were on five or more. This doesn’t include the 38% that were taking an over-the-counter (OTC) medication, as well.

For those who had been hospitalized and needed assistance at a skilled nursing facility, the average number of prescribed medications at discharge was a whopping 14!

If you or a loved one are taking multiple medications, it is important to understand the risks of polypharmacy and how you can take an active role in ensuring all those medications are necessary.

Polypharmacy in the Elderly

As folks age, they tend to have more maladies for which medications may be warranted. The more conditions, the more medications.

For example, have a heart attack and you are likely going to be on four new medications; diabetes six.

Twenty percent of Medicare beneficiaries are diagnosed with five or more chronic conditions consuming upwards of 10 or more medications. Regardless of the individual medications, polypharmacy can increase the risk factor for falls and hip fractures as well as physical and cognitive decline.

Polypharmacy in the elderly is also a leading cause of adverse drug events, or ADEs. The CDC defines ADEs as an event in which medication causes harm to a person.

Understand the Reason for the Medication

Cost and convenience aside, each medication has potential side effects. You should be educated by your providers about the reason for the medication as well as the expected benefit.

For example, if you are diagnosed with osteoporosis, we can estimate your risk of a hip fracture over the next 10 years, and your doctor should recommend a medication if your risk exceeds a certain threshold. But the next question should be what will happen if you take the medication.

Fracture prevention is the obvious answer, but by how much? For osteoporosis, the usual recommended prescribed treatment will reduce the risk of fracture by about 40%. This now becomes a shared decision between you and your provider comparing the expected benefits of the medication with the amount of potential risk that you might be willing to accept.

Polypharmacy Risks and How to Address Them

Unfortunately, the risk of an adverse drug event increases with each additional medication. Polypharmacy in the elderly increases the likelihood of medications interacting with other medications.

My patients frequently ask me about the potential side effects of a particular medication. I often discourage them from pulling out the package insert, flicking it open with a trail of any interaction anyone has ever had in the tiniest font from hand to floor. Instead, I review some of the more serious ones and simply ask that if you are feeling an adverse event, and give me a call, and we can review it.

Be careful about having to take medications to treat the effects of another medication. This is called a prescribing cascade and can lead to unnecessary addition or titration of medications. Sometimes, this is necessary, but the first consideration should be stopping the initial medication.

Don’t be afraid to ask why. Why do I need this medication? Why will it help me? Why do I still need it? Take advantage of surrounding resources to review your medications. In addition to your physicians, there are pharmacists and home health nurses who are experts at making sure your medications are right for you.

References:

Saydah SH. Medication Use and Self-Care Practices in Persons With Diabetes. In: Cowie CC, Casagrande SS, Menke A, et al., editors. Diabetes in America. 3rd edition. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases (US); 2018 Aug. CHAPTER 39. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567996/

https://www.uptodate.com/contents/deprescribing

The content of this site is for informational purposes only and should not be taken as professional medical advice. Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding any medical conditions or treatments.