Tuesday, March 12, 2013

Polypharmacy

Photo by e-MagineArt
Modern medicine provides us with many life-saving prescription drugs. Medications support greater health for many. However, people taking five or more medications are at risk for polypharmacy.

Kathleen Woodruff of the Johns Hopkins School of Nursing explains the prevalence of polypharmacy with these statistics:

"Currently, 44% of men and 57% of women older than age 65 take five or more medications per week; about 12% of both men and women take 10 or more medications per week. These agents include both prescription and over-the-counter (OTC) preparations, such as vitamin and mineral supplements and herbal products."

Older adults are at a higher risk for polypharmacy for the following reasons:
  • As a group, they take more medications than younger people. 
  • Some have problems with vision, hearing, cognition, and fine motor skills that make adherence a challenge.
  • They are likely to be seeing specialists, who may not be coordinating all prescriptions. 
  • Their aging bodies metabolize medicines differently.  
Part of polypharmacy includes "pill burden," a term for difficulty managing multiple medications.  This can be confusing to sort out: "When do I take this pill?" "How many do I take?" "Do I take this with or without food?"  "Do two of my pills look very similar to each other?"  "Is this prescription bottle mine or my spouse's?"  

Polypharmacy leaves people at risk for side effects and for bill burden.

Also, there is a domino effect. People taking medications often suffer side effects, which leads them to take another medication to manage those side effects. This can lead to non-adherence and to even more side effects. And to more pills. This is called a "prescribing cascade." 

If an older adult in your life is experiencing a new symptom, consider discussing the possibility of polypharmacy with his or her physician. Even medications taken over a long period of time can produce new, unwanted side effects as the body ages.  My own step-father suffered internal bleeding that required hospitalization in the intensive care unit.  The offending medication?  Baby aspirin taken over a period of several years.

Brenda Jordan--advanced practice registered nurse and speaker in the podcast below--asks patience and health care providers to first consider drug side effects as the cause for new health complaints.

If you are taking multiple medications, consider the problem of polypharmacy so that you, your doctor and your pharmacist can manage this potential problem.  Check to see if your aging parent has this problem as well.

Note: This blog post serves to raise awareness not to supply medical advice. If you have any questions about your medications, please consult your doctor and your pharmacist.

More Resources:

For more detailed, technical discussion, explore the links embedded above.

Geriatrician Leslie Kernisan has several posts that discuss concerns older adults might have about medications.  Her post "6 common medication problems in aging and what you can do" discusses side effects, pill burden, polypharmacy and expense.

For an informative hour-long podcast on the topic, listen to Benda Jordan, MS APRN, deliver her lecture "Polypharmacy in Older Adults: Balancing the Risks/Benefits of Medications."  This podcast is part of the excellent Dartmouth Hitchock Medical Center series on geriatric nursing. 

This short news story(about 3 minutes) provides an overview of the problems polypharmacy presents:


This more substantial news story (about 8 minutes) features the work of Georgia geriatric pharmacist Armon B. Neel, Jr. who works with doctors and patients to reduce the number of drugs prescribed.


Related: 

Penalty for Enrolling Late in Part D




4 comments:

  1. I'm glad you pointed out that it can also be an OTC that causes a major problem. I know a few people who think that no trouble can come from OTCs or supplements, so they don't even tell their doctors everything they are taking at home.

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  2. Thanks for reading, fadedginger. Yes, patients often hold back on such information, either because they don't perceive it as pertinent or because they don't trust licensed doctors to support nontraditional medicines. I have a family member who holds back this information about herbal supplements.

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  3. It was a nice blog post and entertaining. Keeping healthy was a big responsibility in life. We must be careful on using any incenses such as Herbal Incensebecause mostly it can be dangerous.

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  4. Helpful article. Caveat for those who have a loved one in a nursing home. Many residents are overmedicated with inappropriate drugs to 1) sedate them and make them easier to manage 2) because long-term-care pharmacies push certain medications in kickback agreements with drugmakers. Watch your loved one carefully and insist on informed consent.

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