The Epidemic of Polypharmacy for Seniors

Polypharmacy is a term indicating an individual takes five or more prescription medications a day. This can be devastating to an older person. Find out why this epidemic exists and what medical professionals are doing to combat the effects of polypharmacy.

What is polypharmacy?

While pharmaceutical medications have an important place in daily health maintenance for seniors, there can be harmful outcomes. Prescribers and patients alike are often unaware of the negative results of polypharmacy.

Polypharmacy is defined as taking five or more distinct medications per day. Medications used for treating symptoms, chronic disease management, and extending life may lead to drug interactions and adverse effects, especially in the aged population.

In the U.S., 98% of older adults take five or more medications for their chronic health issues. In senior care facilities, studies show 74% of residents are taking nine or more different drugs daily.

What leads to polypharmacy in aging?

There are diverse reasons why polypharmacy is currently at epidemic proportions.

As the body ages, chronic and acute diseases accumulate. For instance, conditions such as cardiac disease, diabetes, recurring pneumonia, and dementia found within one individual will each require one or more medications to address symptom management or support.

Primary care providers cannot easily share patient records with other specialists. If their patient requires hospitalization, the primary provider is not always aware of new prescriptions received during the admission. Multiple providers prescribing for an individual adds up.

Furthermore, doctors and nurse practitioners are notoriously busy with the pressures of their practices. Time constraints to review an elder’s current medication list and ask about side effects are detrimental. And no provider can know all the subtle or little-known drug interactions offhand.

There is also the fact that many seniors use multiple pharmacies. Individual pharmacists have no access to a comprehensive list of medications. Therefore, they cannot monitor for medication duplications or interactions.

Elders are often unaware of an accurate account of their daily med regime. They are not always mindful of medication errors or negative side effects. In this case, ignorance is never bliss.

Unfortunately, one of the above components is enough to spell danger to an older adult; more may be deadly.

Why are older adults in harm’s way?

The fact that the multiple chemicals interact exists for anyone at any age. In the older body, however, the decreased ability to break down, absorb and then excrete the byproducts from medication metabolization is now a factor.

Existing conditions in seniors such as decreased stomach acid, poor liver function, and kidney failure can lead to adverse drug interactions with polypharmacy.

For example, without full kidney function, toxic levels of byproducts in the blood continue to circulate and will most likely interact with multiple pharmaceutical byproducts with disastrous consequences.

Polypharmacy also leads to non-compliance. Likely, the daily regimes become too complicated for some elders with decreased brain function, poor eyesight, or lack of stamina.

In addition, seeing a handful of pills multiple times a day can be overwhelming. Seniors are known to either pick and choose which ones they take each time or not take them at all.

What are the negative impacts of polypharmacy?

So much can go wrong from the time a senior swallows multiple pills. Adverse drug interactions due to polypharmacy frequently lead to more hospitalizations, falls, delirium, and even death.

Gut flora, stable during life, changes with aging. Polypharmacy adds to the unfavorable ability to support an optimal healthy microbe composition necessary for immune function.

One recent study showed polypharmacy, which included a collection of medications commonly prescribed to older adults, increased inflammation in the digestive tract, leading to infections and worse.

Elders in long-term care facilities are not exempt from the impact of polypharmacy. Drug errors by nursing staff may happen because of a complex drug administration list. In addition, busy nurses aren’t always available to monitor closely for drug-drug interactions.

How is polypharmacy being addressed?

Harm reduction is key. There is a robust movement in geriatric medicine toward what is called deprescribing.

Researchers initiated the START/STOPP criteria for medical practice in 2008. It is an evidence-based tool for screening older individuals’ current medications and guiding prescribers on the most appropriate meds to introduce to an aging patient.

A pivotal measure is embracing pharmacist intervention. In collaborating with a pharmacist, prescribers are now receiving accurate information in working toward deprescribing. In other words, two heads are better than one in reducing the harmful results of polypharmacy.

Pharmacists know when the harms outweigh the benefits when it comes to polypharmacy. Families and caregivers are encouraged to ask their family doctors to review their vulnerable senior’s medication list with a pharmacist.

In addition, watching for new, persistent, or concerning symptoms and reporting them immediately to the medical provider may keep more elders safe.

In conclusion, research on polypharmacy and evidence-based medical practice is growing as the number of older adults multiplies. Polypharmacy may be a necessary part of aging. Luckily, deprescribing is now at the forefront of the minds of medication prescribers who serve seniors. In this case, providers are starting to understand more is not always better.