Polypharmacy in the Elderly. Why too many Medications are bad

Polypharmacy refers to the concurrent use of multiple medications by a patient, typically defined as the use of five or more medications. In the elderly population, polypharmacy is a common occurrence due to the increased prevalence of chronic conditions that require pharmacological management. It is not uncommon for me to see patients over the age of 65 years old that are taking over 15 medications, sometimes over 20. I once saw a pateint that was on 36 medications!

Why is Polypharmacy a Problem

• Increased Risk of Adverse Drug Reactions: Older adults are more susceptible to side effects and drug interactions due to physiological changes associated with aging, such as altered metabolism and organ function. However, they are still often prescribed medications at the same dose as a 40 year old. The rule I use is start low and go up on dose slow if needed.

• Medication Non-Adherence: Managing multiple medications can be complex, leading to confusion and decreased adherence to prescribed regimens. There is some data that suggests that if a person is on 5 medications, they are likely to miss a medication dose about 5 times per week.

• Higher Healthcare Costs: Polypharmacy can lead to increased healthcare utilization, including more frequent doctor visits, hospitalizations, and additional treatments for adverse effects. Retrospective studies tell us that out of every 6 hospitalizations, at least one of them is caused due to polypharmacy.

• Functional Decline: The use of multiple medications can contribute to cognitive decline, falls, and decreased overall functionality in elderly patients. This leads to assisted living placements and then nursing home placements. Older individuals are overwhelmingly not in favor of moving out of their homes when possible. They want to maintain as much independence as they can.

• Inappropriate Prescribing: Polypharmacy often results from the prescribing of unnecessary medications, which can be avoided through careful medication review and management. Use of geriatric specialized providers can significantly reduce this risk.

  
  

I encourage anyone over the age of 65 on multiple medications, to make an appointment with their PCP to review the need, or ask for an appointment with the pharmacist in your PCP's health care system. If they don't have one, ask the pharmacist where you get your prescription medications to set up a meeting. They are generally very willing to help!