What is polypharmacy? It can be explained as the use of multiple medications generally referred to five or more prescribed drugs per day and/or the administration of more medications than are clinically indicated, representing unnecessary/unwanted drug use. [1] World Health Organization has evaluated that in every nine people, there is one elderly person, i.e., age 60 years or older. This value is to be expected to increase to one in five people by 2050, accounting for about half of the total growth of the world population. This demographic transition in the elderly population constitutes a significant challenge for health authorities worldwide as with advancing age, multiple chronic diseases such as hypertension, diabetes mellitus, arthritis, chronic heart disease, renal diseases, etc. are associated. As a result, elderly people tend to take multiple medications in a day that can be called polypharmacy. Various studies globally have shown that on average 2-9 medications per day are taken by elderly people.[1]
Polypharmacy is an area of concern for the elderly because of several reasons. Elderly people are at a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with aging; furthermore, this risk is exacerbated by increasing the number of drugs used. The potential of drug-drug interactions is further increased by the use of multiple drugs. Polypharmacy may sometimes lead to “prescribing cascades.” [4] Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR are misinterpreted as a disease, and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition. This inherits the potential to develop further more side-effects and thus making a prescribing cascade.
The symptoms caused by polypharmacy is unfortunately usually demented with the normal aging signs and symptoms, which can be: Tiredness, sleepiness, or decreased alertness, constipation, diarrhea, or incontinence, loss of appetite, confusion, falls, depression or lack of interest in your usual activities, weakness, tremors, visual or auditory hallucinations, anxiety or excitability, and/or dizziness. For instance, during my career as a nurse practitioner, I have seen a 73-year-old female brought to the clinic for change in mental status. After a thorough evaluation, her change in cognition was due to medication side effects.
Polypharmacy can lead to ADRs, mostly due to over-the-counter medications. The most consistent risk factor for ADRs is the number of drugs being taken, i.e., as the number of drugs taken increases, the risk of ADR increases exponentially. Polypharmacy may also lead to decreased medication compliance, poor quality of life, and unnecessary drug expenses.5
In respect to oral health, the most common adverse effect of polypharmacy reported is dry mouth syndrome or xerostomia. Drugs/medications that can cause a dry mouth include cardiovascular medications (diuretics, calcium channel blockers), anti-depressants and antipsychotics, sedatives, central analgesics, anti-Parkinson’s medications, anti-allergy medications, and antacids.
Evaluation of polypharmacy is of important concern in an elderly patient so as to avoid all the possible adverse effects. Comprehensive medication review and risk assessment should be carried out by an interdisciplinary team to identify the polypharmacy and its adverse effects.
To reduce the incidence and adverse effects of polypharmacy, medication regimes of elderly patients should be evaluated routinely during the visit to the healthcare provider. The elderly should always carry your medication list with you all the time to every provider.
Identifying and avoiding polypharmacy can lead to better outcomes in elderly patients and also helps in improving the quality of life. Medication review is an essential part of the elderly patient to avoid adverse effects that can be caused due to polypharmacy.
The team at Cherished Hands Home Health will review your medications list and collaborate with your healthcare provider as needed.
Always keep your medication list with you. At Cherished Hands, we cherish you and your loved ones.
References
1. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5(4):345–51. [PubMed] [Google Scholar]
2. Rochon PA, Gurwitz JH. Optimizing drug treatment for elderly people: The prescribing cascade. BMJ. 1997;315(7115):1096–9. [PMC free article] [PubMed] [Google Scholar]
3. Abdulraheem IS. Polypharmacy: A risk factor for geriatric syndrome, morbidity &mortality. Aging Sci. 2013;1:e103. [Google Scholar]
4. American Dental Association. Medication, Polypharmacy and Oral Health.
Available from: http://www.dentalhealthweek.com.au/…/facts…/Polypharmacy.pdf