Polypharmacy is a term used to describe the use of multiple medications by an individual. It is commonly defined as being on 5 or more medicines concurrently. Polypharmacy is a major concern for healthcare providers, especially in the older population with multimorbidity, as it can lead to various negative outcomes and increased healthcare costs (Fried et al., 2014).
The prevalence of polypharmacy is high among older adults due to the increased incidence of chronic diseases with increasing age (De Oliveira et al., 2020). As individuals age, they are more likely to develop multiple health conditions that require pharmacological management. Each of these conditions may be treated with one or more medications, leading to the use of multiple drugs.
Several factors contribute to the occurrence of polypharmacy. Firstly, the management of chronic conditions often requires a combination of medications targeting different aspects of the disease. For example, a patient with hypertension and diabetes may require antihypertensive agents, antidiabetic drugs, and lipid-lowering agents to control their multiple risk factors. Secondly, a lack of coordination and communication among healthcare providers can result in duplicate prescriptions or the addition of new medications without considering the potential interactions with existing ones (De Oliveira et al., 2020).
Polypharmacy is associated with several negative outcomes, including an increased risk of adverse drug reactions, medication errors, drug interactions, and medication non-adherence (Marengoni et al., 2011). Adverse drug reactions are one of the most common preventable causes of hospital admissions among older adults, and polypharmacy is a significant risk factor for their occurrence (Jani et al., 2018). The greater the number of medications an individual takes, the higher the likelihood of experiencing adverse drug reactions.
Furthermore, the presence of multiple medications increases the complexity of medication regimens and can lead to medication errors. Older adults, who often have cognitive impairments or visual difficulties, may have difficulty managing their medication schedules and may inadvertently take the wrong medications or the wrong doses. Medication errors can have serious consequences, including hospitalizations, functional decline, and mortality (De Oliveira et al., 2020).
Drug interactions are another concern associated with polypharmacy. The simultaneous use of multiple medications increases the likelihood of a pharmacokinetic or pharmacodynamic interaction, potentially leading to decreased drug effectiveness or increased toxicity (Spinewine et al., 2020). Older adults are particularly vulnerable to drug interactions due to age-related changes in drug metabolism and elimination.
Lastly, polypharmacy can contribute to medication non-adherence. The complexity of medication regimens, frequent dosage adjustments, and potential side effects can make it challenging for individuals to adhere to their prescribed regimens. Non-adherence can result in suboptimal treatment outcomes and disease progression, leading to increased healthcare utilization and costs (De Oliveira et al., 2020).
In conclusion, polypharmacy, defined as being on 5 or more medications, is a major concern for healthcare providers, particularly in the older population with multimorbidity. The use of multiple medications is common among older adults due to the high prevalence of chronic conditions. Polypharmacy is associated with various negative outcomes, including increased risk of adverse drug reactions, medication errors, drug interactions, and medication non-adherence. Healthcare providers should be aware of the potential risks associated with polypharmacy and take steps to minimize its occurrence by employing comprehensive medication reviews, coordinating care among different healthcare providers, and promoting patient education and medication management strategies.
De Oliveira, G. S., Junior, J. F., Jorgensen, L. B., & Chan, B. K. (2020, April). Polypharmacy Among Patients Receiving Community Health Center Services in the United States. In Forum for Health Economics & Policy (Vol. 23, No. 1, pp. 1-25). De Gruyter.
Fried, T. R., O’Leary, J., Towle, V., & Goldstein, M. K. (2014). Health outcomes associated with polypharmacy in community-dwelling older adults: a systematic review. Journal of the American Geriatrics Society, 62(12), 2261-2272.
Jani, Y. H., Barber, N., Wong, I. C., & Lee, K. K. (2018). Adverse drug reactions in older people: A comparison of two UK population-based studies. Age and ageing, 47(1), 80-86.
Marengoni, A., Pasina, L., Concoreggi, C., Martini, G., Brognoli, F., & Nobili, A. (2011). Understanding adverse drug reactions in older adults through drug–drug interactions. European journal of internal medicine, 22(2), 150-157.
Spinewine, A., Fialová, D., Byrne, S., & The European Geriatric Medicine Society (2019). The role of the pharmacist in optimizing pharmacotherapy in older people. Drugs & aging, 36(5), 409-419.