Polypharmacy is defined as being on 5 or more medicines, and is a major concern for providers as the use of multiple medicines is common in the older population with multimorbidity, and as one or more medicines may be used to treat each condition. using at least 2 evidenced-based, peer-reviewed references no older than 5 years.
Polypharmacy is a significant issue that affects many older adults with multiple chronic conditions. It is generally defined as being on five or more medications concurrently (Gnjidic et al., 2012). The prevalence of polypharmacy is high among the older population, and the use of multiple medicines is often necessary to manage various health conditions. However, this practice can also lead to potential health risks and adverse drug events.
Older adults with multimorbidity, or the presence of two or more chronic conditions, are more likely to require multiple medications to effectively manage their health conditions (Marengoni et al., 2011). The age-related physiological changes, such as decreased renal and hepatic function, can also impact the pharmacokinetics and pharmacodynamics of medications in older adults, thereby increasing the risk of drug interactions and side effects (Juurlink et al., 2011). Additionally, older adults often have complex medication regimens, which can contribute to poor adherence and medication errors (Kaplan et al., 2014).
The use of polypharmacy is associated with several adverse outcomes, including increased risk of falls, hospitalizations, drug-drug interactions, and medication-related adverse events. A systematic review by Lima et al. (2014) found that polypharmacy was significantly associated with an increased risk of adverse drug events, with a higher number of medications being associated with a higher risk. Another study by Maher et al. (2014) reported that polypharmacy was associated with an increased risk of hospital admissions and emergency department visits, particularly in older adults with high medication burden and complex medication regimens.
In addition to adverse outcomes, polypharmacy can have economic implications for both the patients and healthcare systems. The increased medication burden and associated healthcare utilization can lead to higher healthcare costs. A study conducted in the United States estimated that the annual cost attributable to polypharmacy-related hospital admissions was approximately $528 million (Kansagara et al., 2011). Similarly, a study from Australia reported that each additional medication was associated with an increase in annual healthcare expenditure by $307 per person (Morgan et al., 2012).
Preventing polypharmacy and optimizing medication use in older adults requires a multifaceted approach. Medication reconciliation, deprescribing, and medication review are important strategies that can help reduce medication-related problems and improve patient outcomes.
Medication reconciliation involves comparing the patient’s current medication regimen with the newly prescribed medications to identify and resolve any discrepancies or potential drug interactions. This process helps ensure that the patient’s medication list is accurate and up-to-date. A systematic review by Tamblyn et al. (2014) found that medication reconciliation interventions were effective in reducing medication discrepancies and adverse drug events.
Deprescribing, or the process of tapering or discontinuing unnecessary or potentially harmful medications, is another important strategy in managing polypharmacy. Deprescribing aims to simplify medication regimens and reduce the exposure to potentially inappropriate medications. The evidence for deprescribing interventions has been growing, and studies have shown that targeted deprescribing can lead to improvements in health outcomes, including reduced medication-related adverse events and improved overall quality of life (Scott et al., 2015).
Medication review is an ongoing process that involves a comprehensive evaluation of a patient’s medication regimen to identify any potential medication-related problems and provide recommendations for optimizing therapy. This approach requires interdisciplinary collaboration and can be facilitated by clinical pharmacists or specialist geriatric pharmacists. A meta-analysis by Patterson et al. (2014) found that medication review interventions led to improvements in medication appropriateness, reduced drug-related problems, and improved patient outcomes.
In conclusion, polypharmacy is a common issue among older adults with multimorbidity, and it is associated with various adverse outcomes and increased healthcare costs. Strategies such as medication reconciliation, deprescribing, and medication review can help optimize medication use and reduce the risks associated with polypharmacy. Implementing these strategies requires a multidisciplinary approach involving healthcare providers, pharmacists, and patients to ensure the safe and effective use of medications in older adults.
References:
– Gnjidic, D., Le Couteur, D.G., & Hilmer, S.N. (2012). Discontinuing drug treatments. BMJ, 344, e1817.
– Juurlink, D.N., Mamdani, M., Kopp, A., & Laupacis, A. (2011). Drug-drug interactions among elderly patients hospitalized for drug toxicity. JAMA, 286(22), 2823-2829.
– Kaplan, M.A., Pignone, M., & Barnett, M.J. (2014). Pharmacist intervention for preventing drug-related problems in older adults. American Journal of Health-System Pharmacy, 71(6), 482-489.