Polypharmacy in the elderly: Are you at risk?

Reviewed by Dr. Richard Fox, MD — Taking multiple pills and prescription medications throughout the day can increase the risk of adverse health effects. In fact, the more medications a person takes, the more severe the outcome. Older populations already bear an increased risk of developing a range of diseases. Many are currently taking medications to treat existing conditions, and these numbers are likely to increase. Many may fall victim to polypharmacy.

It is estimated that by 2040, there will be approximately 82 million people age 65 or older in the United States, representing more than 20% of the population.

Current estimates suggest that a quarter of Americans ages 65 to 69 take at least five medications. For people ages 70 to 79, that number jumps to nearly 46%.

Administering all of these medications can pose multiple risks to an aging population.

What is polypharmacy?

Polypharmacy is a term you may not be familiar with. It is likely to be more common among doctors, pharmacists, and other professionals involved in providing your medication.

But that doesn’t mean you shouldn’t be aware of it or its potential risks.

As the name suggests, polypharmacy means taking multiple medications at once.

Sometimes the exact number is up for debate, but the magazine American family physician Polypharmacy is defined as taking five or more medications regularly.

These medications can include any prescription medications used to treat or manage chronic health conditions, while extending to over-the-counter (OTC) medications and even nutritional supplements.

Polypharmacy in older adults is very common and has the potential to increase their risk of various negative health outcomes and physical and financial difficulties.

Risks of polypharmacy

Concomitant use of multiple medications can pose several risks.

Medicines may interact negatively with each other. Ingredients in one drug can override the effects of those in another. Some ingredients in different medications can combine to create a toxic environment.

Furthermore, different combinations of ingredients may impair brain function and movement. The more medications a person takes, the greater the chance that one of these substances will cause a problem.

Let’s take a closer look at some of the problems that can result from polypharmacy.

Adverse drug interactions

The risk of some type of drug interaction increases with each drug added to the mix.

One study found that more than 20% of adverse drug reactions result from basic drug interactions between drugs. This can be very dangerous for frail people with serious health problems.

Another study found that hospitalized older adults taking five or more medications were 80% more likely to have an adverse drug interaction than those taking fewer medications.

Patients taking between five and nine medications had a 50% chance of interactions, and that number jumped to 100% when patients took 20 or more medications.

Increased risk of falling

Common medications that affect the central nervous system (CNS) can cause drowsiness and confusion, increasing the risk of falling. Some examples include:

Study published in JAMA Internal Medicine It found that CNS polypharmacy more than doubled between 2004 and 2013, creating a significant risk of hip fractures.

Negative side effects of medications

As mentioned, each additional medication increases the risk of severe side effects.

Same thing JAMA Internal Medicine The study mentioned above found that certain combinations of blood thinners (including aspirin) are more likely to increase the risk of bleeding after long-term use.

Other research has shown that hospital outpatients who take five or more medications have an 88% higher risk of experiencing adverse drug effects, compared to those who take fewer medications.

High health care costs

Obviously, the more medications you have to take, the higher your healthcare costs will be. Factor in treatment or hospitalization for potential adverse reactions, and these costs can add up.

It is also possible that you are taking an ineffective medication. This also adds to the cost of treatment.

Non-compliance

Taking multiple tablets every day can be a daunting task. Remembering how to take each as prescribed can become increasingly difficult, especially if you have to take certain medications on specific days, at specific times, in specific doses, etc. All of this can contribute to reduced medication adherence.

Cognitive impairment

Polypharmacy has also been linked to dementia and delirium.

One study looked at 294 older adults and noted that cognitive impairment was associated with taking medications.

The researchers found that:

• Twenty-two percent of patients taking five or fewer medications had cognitive impairment.
• Cognitive impairment jumped to 33% among people who took between six and nine medications.
• Fifty-four percent of people experience cognitive impairment when taking 10 or more medications.

How to prevent polypharmacy

Preventing polypharmacy actually comes down to transparency and your doctor’s opinions about which medications you should take and which ones you can do without.

Open communications

Do your best to tell your doctor everything you take — from nutritional supplements to over-the-counter and prescription medications — for each condition. This provides them with the information they need to determine what may be unnecessary, or which alternatives may work better for you, or different combinations of pills.

It’s also a good idea to talk to your local pharmacist when you’re considering purchasing an over-the-counter medication or supplement or filling another prescription.

a description

Prescribing is a strategy that doctors can use to reduce the risk of polypharmacy. The term prescribing can describe a systematic review of medications to either reduce or stop them.

Your doctor will have to look at your specific condition to determine a risk-benefit analysis, and then decide if there is a way to simplify your medication regimen while ensuring that your treatment continues appropriately.

It is highly recommended that you speak with your doctor if you are concerned about the medication you are taking, or if you are taking products that he or she does not know about.

Under no circumstances should you stop taking a prescribed medication of your own volition in an attempt to reduce the risk of polypharmacy. Always consult your doctor before making a change to your treatment plan.

There are some screening tools you can ask your doctor to use to evaluate your medication use:

• It starts (A screening tool to alert doctors to appropriate treatment)
• Stop (Prescription screening tool that may be inappropriate for the elderly)

Talk to your doctor about polypharmacy

Talk to your doctor if you take five or more medications. They can help determine if you are eating anything that is excessive or putting your health at risk. The fewer medications you can safely take, the better your chances of avoiding a negative interaction or effect.