Polypharmacy and Older Adults

Adverse  polypharmacy  is a significant problem in elderly adults.  Polypharmacy is defined as the use of a number of different drugs, possibly prescribed by different doctors and filled in different pharmacies, by a patient who may have one or several health problems.

 A  study  to determine whether medication review would simplify regimens in older adults was reviewed  in a 2004 article in  the Journal of the American Geriatrics Society.  Although the intervention significantly reduced the medications taken and monthly cost, most patients were resistant to reducing medications to the recommended level. Further study is needed to understand patient resistance to reducing adverse polypharmacy and to devise better strategies for addressing this important problem in geriatric health. Greater focus on prescriber behavior is recommended.

Participants were unwilling to follow suggestions to discontinue psychoactive drugs from their medication regimens. In this study, subjects were informed that their primary physician agreed to the recommended changes, but when advised to discontinue specific medications, patients accepted this advice only one-third of the time.

 According to Dr. Jerry Johnson, older Americans make up about 12 percent of the population but take roughly a third of all medications consumed in the US.  Older adults taking multiple drugs may suffer delirium – temporary confusion that can be mistaken for dementia.

Dr. Johnson offers older adults and their caregivers this advice on avoiding adverse drug effects:

• Read labels – Review each drug, vitamin, and supplement label carefully, checking the  dosage and precautions, including precautions concerning adverse drug interactions 
• Be loyal to your pharmacist – Use only one pharmacy to fill your prescriptions. That way your pharmacist will have information about all of the prescription drugs you’re taking and will be more likely to recognize when a newly prescribed drug may interact with others. 
• Create a list – Make a list of all the prescription and over-the-counter drugs, herbal products, vitamins, homeopathic remedies, and supplements you’re taking, at what doses, and how often. Carry the list with you. That way, you’ll be able to show it to your healthcare providers when you have appointments, and to emergency medical staff should you need emergency care.
• Ask for professional help checking for interactions – Ask your pharmacist or doctor to run your medication list through a drug interactions database to identify possible problems, especially if you’re taking five or more drugs.
• Study your medications – Learn the names of your medications and what they treat. 
• Make sure your healthcare providers know what others are prescribing– If you have more than one doctor, make sure each knows what the other is prescribing.

Sources

Williams, M. E., Pulliam, C. C., Hunter, R., Johnson, T. M., Owens, J. E., Kincaid, J., & ... Koch, G. (2004). The Short-Term Effect of Interdisciplinary Medication Review on Function and Cost in Ambulatory Elderly People. Journal Of The American Geriatrics Society, 52(1), 93-98.

Dr. Jerry Johnson, Multiple Medications: A Leading Cause of Delirium and Other Adverse Effects Among The Elderly ,http://www.americangeriatrics.org/press/reporter_resources/clinical_story_topics/id:146