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Polypharmacy is the use of multiple medications by the same individual to treat different health conditions. Polypharmacy can increase the risk of adverse reactions through unexpected drug interactions and medication errors. Especially in older adults who have more medical conditions, they are more likely to be prescribed multiple medications, which can exacerbate the risk of polypharmacy.
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Trends and statistics
The prevalence of polypharmacy can vary by age, gender, and health status. According to statistics, the prevalence of polypharmacy among adults aged 65 years or older is approximately 40%, while the prevalence of polypharmacy among adults aged 85 years or older is increased up to 70%.
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What causes polypharmacy?
Usually, there are several factors contributing to the development of polypharmacy, these including:
- Multiple conditions (Different doctors, different conditions)
As you age, when you have multiple medical conditions, you may see different doctors to manage different conditions. It is common that they do not really question much about the drug compatibilities. - Fragmentated care (Different doctors, same conditions)
When you receive care from multiple healthcare providers for the same condition, each healthcare provider may prescribe medications without finding out too much of what other medications you are taking. Sometimes, poor communication between healthcare providers and patients can lead to duplicate or unnecessary medications. - Medication side effects (Same doctors, different conditions)
When you experience side effects or secondary condition from a medication, healthcare providers may prescribe additional medications to manage the side effects. A common example is prescribing antacid when you are taking strong painkillers. - Overprescribing (Same doctors, same conditions, different time)
Sometimes, healthcare providers may prescribe more medications than necessary or changing new drugs for your same conditions, leading to too much prescriptions and confusion. - Self-medication
Very often, you tend to self-administer some off-the-counter (OTC) medications, complementary medicine (e.g., TCM), supplements recommended by people, etc. These medications when taken together with others medicines, they may cause undesired drug-interactions and responses.
Implications and complications
There are several implications of polypharmacy that if left untreated, can lead to other severe complications, for example:
- Adverse drug reactions
The more medications you take, the higher their risk of experiencing adverse drug reactions. This can lead to hospitalization, disability, or even death. - Drug interactions
When two or more medications interact, it can affect the effectiveness and safety of the medications. Some drug interactions can be serious and require medical attention. - Decreased medication adherence
Taking multiple medications can be overwhelming and confusing, which can lead to decreased medication adherence. This can result in poor health outcomes and disease progression. - Cognitive impairment
Some medications used in polypharmacy regimens can cause cognitive impairment, such as confusion and memory problems. - Falls and fractures
Certain medications used in polypharmacy regimens, such as sedatives and antipsychotics, can increase the risk of falls and fractures, especially in older adults. - Organ damage
Taking too much medications over time can cause organ damage, such as kidney and liver damage. - Increased mortality
Polypharmacy has been associated with increased mortality, especially in older adults.
It is important for healthcare providers to carefully consider the risks and benefits of each medication before prescribing them to patients to minimize the complications associated with polypharmacy.
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How to avoid polypharmacy?
Preventing polypharmacy involves a collaborative effort between patients, healthcare providers (nurses, pharmacists, doctors), and caregivers. Here are some ways to prevent polypharmacy:
- Regular medication reviews with healthcare provider can help identify unnecessary or redundant medications and ensure that each medication is still necessary and effective.
- Good communication between patients, healthcare providers, and caregivers can help prevent duplicate prescriptions and ensure that each provider knows what medications the patient is taking.
- Reconcile and ensure that patients’ medication lists are up-to-date and accurate when transitioning between healthcare settings (such as hospital to home) can prevent medication errors.
- Reducing the number of medications a patient is taking (deprescribing), particularly for those with multiple chronic conditions. It can be done in collaboration with healthcare providers and can help simplify medication regimens.
- Educating patients about their medications, including the reason for each medication, how to take them, and potential side effects, can help improve medication adherence and prevent medication-related problems. Provide written instructions and medication schedules to help patients manage their medications.
- Healthcare providers can explore non-pharmacological treatments such as lifestyle modifications or physical therapy without over-reliance to medications.
- Electronic health records can provide healthcare providers with real-time access to a patient’s medication list, which can help prevent duplicate prescriptions and undesired drug interactions.
- Consider simplifying the medication regimen by using combination drugs or reducing the frequency of administration of medications.
- Consider the use of medication adherence aids, such as pill organizers or reminder systems, to help patients remember to take their medications as prescribed.
- Monitor patients for adverse effects of medications, including side effects, drug interactions, and changes in laboratory values.
Conclusion
It is important to note that polypharmacy can increase the risk of adverse drug reactions and interactions, which can lead to poor health outcomes. To mitigate the risks associated with polypharmacy, healthcare providers should carefully evaluate each medication prescribed to a patient and consider the potential benefits and risks of each.
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Patient should also work closely with healthcare providers to review medication regimen to ensure that it is still appropriate and effective. A patient education session is helpful for patients to understand their medications and encourage them to take an active role in managing their medication regimens. Patient should not take expired medicines leftover from previous medical appointment, or administer medicines for condition that you think is similar with previous conditions.
Polypharmacy is also unsafe for older adults as many medicines that may look alike but have opposite effects. If you are unsure, bring your medications to your doctor for advice. Otherwise, you should discard all expired or unsure medications.
