Preventing polypharmacy in the elderly

Although most are motivated to take medications as prescribed, some fail due to misunderstanding, confusion, forgetfulness.

By Carrie Schanen, PharmD

Polypharmacy refers to multiple medications being taken concurrently to manage coexisting health problems. Since polypharmacy is a consequence of having several comorbidities, it is more common among the elderly where an estimated 30 to 40 percent of patients take at least five or more medications daily.

Polypharmacy can become problematic when a patient is prescribed multiple medications by multiple providers with no single provider knowing the patient’s complete medication profile.

Many Hands

Elderly patients often seek treatment from multiple healthcare providers who work independently of each other. For example, a cardiologist may prescribe two or three medications for heart failure based on evidence-based guidelines, and then an endocrinologist may do the same when managing diabetes. This same patient may also be taking a couple of over-the-counter medications to treat acid reflux or indigestion as well as a few vitamins and herbal supplements, and before you know it the patient is taking 10 or more medications daily.

Sometimes an unwanted side effect from one drug goes unrecognized or is misdiagnosed, causing a new medication to be prescribed rather than considering stopping or changing the dosage of the offending agent to solve the problem. This is referred to as the prescribing cascade, and it can greatly increase the risk of an adverse event, particularly among the elderly.

Another contributing factor to polypharmacy is the lack of complete documentation about why a medication was initially prescribed. This missing piece of information can make medication reconciliation and any decisions to discontinue medications difficult, especially for providers who are not the initial prescribing physician.

Of Concern

In general, the more medications a person takes, the greater the risk of an adverse event or drug interaction. Polypharmacy increases the burden on many elderly patients to remember when and how to correctly take their medications, resulting in adverse events due to inappropriate usage or nonadherence. In addition, these adverse events contribute to avoidable medical costs since most will require some type of physician intervention or could even result in hospitalization.

According to the U.S. Department of Health and Human Services, older adults account for about 35 percent of all hospital stays, and more than half of these visits are due to drug-related complications.

Take Action

Be sure to complete a comprehensive review of all the medications a patient is taking at every office visit, and don’t forget to document why each medication is being used. Encourage your patients to keep a list of all their medications, including any OTC or herbal supplements, as this can help you to identify and mitigate potential drug interactions.

Encourage patients to use one pharmacy to obtain their medications. This ensures medication records are kept at one central location, enabling pharmacists to identify any drug interactions or therapeutic duplications that may occur when patients are seeing several different providers.

When completing medication reviews during the office visit, consider stopping medications that may not be medically necessary to reduce the pill burden for your elderly patients and to decrease the chances of an adverse drug event from occurring.

-Carrie Schanen, PharmD, is with KentuckyOne Health Partners.

 

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