What is Polypharmacy in Older Adults?

With an increasingly aging population and available treatment options, there is a growing concern about polypharmacy becoming all too common in the elderly. Polypharmacy is defined as the simultaneous use of multiple drugs by a single patient for one or more conditions. While medications are meant to help with ailments or disease, excessive or unnecessary treatments increase the risk of adverse drug effects, including fragility and cognitive impairment, harmful drug interactions, and drug-disease interactions. This article will discuss recognizing polypharmacy, its symptoms, and dangerous consequences, plus strategies for reducing or eliminating the risks for your loved one.

How to Recognize Polypharmacy

Understanding medications are vital to preventing and managing polypharmacy. Typically, seniors taking five or more drugs could be an indication of inappropriate polypharmacy. However, it is more complex than just the number of drugs someone takes. Identifying polypharmacy involves the following criteria:

• Taking medications that have no apparent indication
• Using therapeutic alternatives to treat the same illness
• Simultaneous usage of interacting medications
• Using an unsuitable dosage
• Taking other medications to treat adverse drug reactions

Polypharmacy Symptoms

Our older population is more susceptible to falling into a polypharmacy situation because they are often required to take multiple medications due to growing and various health issues. Additionally, their bodies cannot process the harmful effects of medicines in the same way as their bodies did when they were younger.

Seniors and their caregivers can look for common symptoms of adverse reactions and drug interactions developing from polypharmacy. The common signs or symptoms of polypharmacy include the following:

• Loss of appetite
• Falling
• Confusion
• Weakness
• Tremors
• Dizziness
• Anxiety
• Depression and more

Polypharmacy Examples

There are many examples of polypharmacy, which are usually broken down categorically. These include minor, major, excessive, and other categories of usage. Three main categories for reference include excessive polypharmacy (EPP), polypharmacy (PP), and no polypharmacy. The first category, excessive polypharmacy (EPP), is an individual's concurrent use of 10 or more different drugs. Secondly, polypharmacy (PP) uses 5 to 9 drugs. And third is no polypharmacy, which means an individual is taking 4 or fewer drugs (including those taking no medicines).

Risk Factors and Consequences of Polypharmacy

Polypharmacy risk factors can occur at the patient and the health care system level, putting geriatric patients at increased risk of multiple adverse outcomes. Consequences of polypharmacy may include negative drug reactions, falls, hospitalizations, nursing home placement, malnutrition, pneumonia, and even death.

Two major patient-related risk factors include (1) having multiple medical conditions managed by different subspecialist physicians and (2) having chronic mental and physical health conditions. On the other hand, systems-level risk factors include poorly updated medical records, automated refill services, and prescribing to meet disease-specific quality metrics.

Strategies for Reducing Polypharmacy for Older Adults

While a specific assessment or tool has not been proven to combat polypharmacy, there are many strategies for seniors, caregivers, physicians, and pharmacists to help prevent it. For instance, patients, their families, and physicians should secure an accurate list of medications and conduct medication reconciliations, effectively eliminating duplicate medications, assessing for drug-drug interactions, and reviewing dosages. Healthcare providers may also work to simplify, deprescribe, or modify medication regimens while still maintaining effectiveness as the patient ages and condition(s) change.

A tactic to prevent overuse of medications, could be setting a medical alert system that can guide the exact intake of medcations.

Questions About Medications

Before starting a new medication, have your loved one, their caregiver, and healthcare provider address these helpful questions from American Family Physician Journal (AFP Journal):

• Are there underlying causes for the issues or symptoms the patient is experiencing that should be discussed first?
• Is the new medication/treatment necessary for the patient's condition?
• Are there nonpharmacologic therapies that can be considered?
• Are there preventive measures that can be tried first?
• Are there benefits? Are there proven outcomes and benefits?
• What are the risks?
• What are the patient's goals of therapy?
• What is the patient's estimated life expectancy when considering age?
• Is the patient consistently taking current prescribed medication?
• Can the patient afford this medication?

If you find this list of questions helpful, please consider reading our next article, “What is the Difference Between Medicare and Medicaid?” which will answer questions you may have about governmental programming coverage for medication and care.

Find a Senior Care Community in Your Area  

Various senior care communities are available to help you or your loved one with the assistance of daily activities, including medication management. Find a caring community that best suits your needs and feel supported by a compassionate, professional team of staff eager to help and care for your physical, mental, and emotional needs.

Referah works directly with seniors, their families, and (by extension) medical advisors to identify which type of care and support is best. Talk to one of our experts about finding professional care and start exploring senior living communities today.