Polypharmacy- An Emerging Health Issue In Elderly

A guide for patients

More people than ever are taking a multitude of medicines and supplements, but do we really know what it does to us?

So what exactly is Polypharmacy?

Polypharmacy is the concurrent use of multiple medications by a patient. There is no as such standard definition of polypharmacy. It can be explained as the use of multiple medications generally referred to five or more prescribed drugs per day. Taking a multitude of medicines, whether they are prescription drugs, OTC treatments, herbal or dietary supplements — is known as polypharmacy.

Medicines are sometimes necessary and provide some of the most effective treatments in the world. But all too often, they are used in a way that undermines their value:

Sometimes you have doctors prescribing them when they shouldn’t be, or not prescribing them when they should be. To top it, patients often self-medicate and take them incorrectly or combine them with over the counter medicines or supplements in a way that could be a dangerous concoction.

It is crucial that patients are empowered to make informed decisions about the medicines they are taking, and pharmacists and other healthcare professionals have an important role in educating patients to make these decisions.

Now, I’m sure most of you reading this probably face this scenario right?

Although it can potentially concern people of all ages, the elderly are most at risk.

The availability of a greater number of drugs, the increase in life expectancy and a higher prevalence of chronic diseases represent the main reasons for a higher incidence in this population. Elderly people are also t a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with ageing;

So, what’s the big deal?

Polypharmacy is not just an inconvenience as most patients often complain about. It may lead to decreased medication compliance, poor quality of life, and unnecessary drug expenses but it doesn’t stop there.

The main issue here is a patient’s safety because of the increase adverse drug reactions and the incidence of drug on drug interactions.

There is always a balance of risk vs benefit from medicines. Over time or depending on circumstances the balance and equation may change.

The more medicines and supplements a patient takes, the higher their risk of adverse situations including serious ones, from these combinations, rather than from the underlying illnesses they are designed to treat.

For example, combining the blood-thinning medicine warfarin with aspirin can increase the risk of major bleeding, such as gastrointestinal haemorrhage.

Polypharmacy may sometimes lead to “prescribing cascades.” Prescribing cascade is said when signs and symptoms of an Adverse Drug Reaction (ADR) is misinterpreted as a disease and a new treatment is further added to the earlier prescribed treatment to treat the condition.

The symptoms caused by polypharmacy is unfortunately usually confused with the normal ageing signs and symptoms, which can be: Tiredness, sleepiness, or decreased alertness, constipation, diarrhoea, or incontinence, loss of appetite, confusion, falls, depression or lack of interest in your usual activities and so on.

Complicating matters further, many people like to take medicines, and healthcare providers like to prescribe them. It has long been perceived that a doctor’s visit is not complete without a prescription for medicines.

Thinking through the medication list

Optimising medicines is a time-consuming, multidisciplinary process that requires extensive communication, frequent monitoring and review, and has a major clinical impact.

Management strategies

As a patient is it important that you learn about your medication and why you are taking them, and ensure that each provider or prescriber that sees you is aware of the totality of treatments that you are using.

1) To reduce the incidence and adverse effects of polypharmacy, your medication regimes should be evaluated monthly.

2) You might want to consider a medication review after significant transitions such as hospitalisation or when a new diagnosis comes up.

3) You should also work together with your general practitioner to liaise with specialists to ensure agreement on therapeutic goals when it comes to the medication you are taking. Where reaching concordance is difficult, a second opinion from another GP or a geriatrician may help.

4) You and your family need to be reassured that medicines are being changed to achieve their therapeutic goals. It must be clear that if drugs are ceased it is because they are causing harm or are of no benefit, and not because you are 'not worth treating'.

5) When possible, a single drug should be prescribed instead of multiple drugs for the treatment of a single condition. Medications should be started with the lower drug dosage and if required incremental increase can be done.

6) Drugs that can be given once or twice a day should be preferred over the drugs given three times a day.

7) Drugs that are suspected to cause a problem or it has no therapeutic benefit should be stopped. Unessential drugs should be identified and eliminated.

Conclusion

The development of smartphone apps, clinical-decision support systems using newly-developed artificial intelligence technology, and giving patients online access to their electronic medical records, also show promise to improve the safety and appropriateness of prescribing and improve patients’ knowledge of their medication. However, it is still a long way to go before patients can rely on technology to solve this problem.

In the meantime, the best thing patients should do is to maintain good communication with their primary care physician to prevent or minimize problems associated with polypharmacy.

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