What Is Meant by Polypharmacy?
Polypharmacy is a term used when a person takes more than five medications or uses inappropriate medicines, such as
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Inappropriate medications include those medicines with no appropriate therapeutic usage.
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Multiple medications are prescribed to treat the same health condition.
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Using interacting medications.
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No proper medication dosages.
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Medicines are used to counteract the side effects caused by the intake of other medications.
How Does Polypharmacy Affect Elderly People?
As the elderly population tends to rise in the United States, so does polypharmacy. Those elderly individuals 65 years and older comprise more than 13 percent of the population, taking 30 percent of all the prescribed medications. The elderly population contributes about three billion dollars in annual prescribed drug sales. This population usually takes about four to five medications. Due to the intake of many medications, the older population is more susceptible to
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Anticholinergic side effects caused by medications.
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Orthostasis.
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Cognitive changes.
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Enhanced risk of fall.
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The difficulty of medication adherence.
Appropriate drug therapy is essential to treat any medical condition. Excessive use of drugs or medication can result in severe adverse reactions. Usually, older people follow a complex drug regime, which includes many medications that can increase the risk of other complications. A multidisciplinary health care professional can help to deal with polypharmacy in elderly people.
What Are the Criteria Used to Identify Polypharmacy in Elderly People?
Some criteria used are:
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The person takes medication without any apparent indication.
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Intake of medications that are therapeutically equal to treat the same medical condition.
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Regular use of interacting medicines.
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Intake of medications with improper dosage.
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Use of other medications to manage the adverse effects of other medications.
Polypharmacy can result in drug-drug interaction or drug-disease interaction. Polypharmacy puts older people at greater risk due to natural physiological changes that occur as a person ages. The physiological alteration can reduce renal and hepatic functions, contributing to changes in pharmacodynamics and pharmacokinetic processes.
What Are the Different Types of Polypharmacy?
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Therapeutic Polypharmacy:
In this type, various drugs are recommended to the patient and are closely observed by the doctors as many drugs or medications are required for managing the medical condition.
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Contratheraupetic Polypharmacy:
This polypharmacy occurs when the person experiences sudden adverse side effects under a drug regime and is not monitored by the doctor. This polypharmacy is a severe condition where the person is under many medications for a prolonged period, especially in higher dosages, and is not monitored by the doctor.
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Polypharmacy and Adverse Drug Reaction:
The common concern of all forms of polypharmacy is the adverse reaction caused by the medication and the drug-drug interaction. However, in some instances, it is required to prescribe multiple medications to treat the condition. In such cases, the doctor should monitor for any adverse effects.
Almost 75 percent of adverse drug reactions cause hospitalization and occur due to known pharmacological medications and are usually due to inadequate monitoring by the doctors, no proper prescription, and lack of education to the patient.
In the case of older adults, the adverse effects caused by the intake of multiple drugs can be confusion, falls, urine retention, inconsistency, or malaise, which can resemble geriatric syndrome. In such cases, the physicians may recommend an extra drug to treat this condition, which needs to be monitored carefully.
How Can Polypharmacy Be Managed?
Awareness regarding polypharmacy and the adverse effects caused by the patient is created. Preventing polypharmacy is the best way to manage patients. In the case of polypharmacy, the patient and the doctor should be proactive rather than reactive. Pharmacists can help by providing
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Medication reconciliation.
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Medication therapy management.
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Patient counseling in person.
The doctor should do medication reconciliation on every patient visit to know the proper use of the medicine. Some tips for the pharmacist on polypharmacy are:
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Patients' medications should be checked at every visit to the doctor.
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Medication reconciliation should be done by
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Ensuring the dosage and route of administration.
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Evaluating the time appropriately.
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Know that the medical condition persists and remove the no longer needed medications.
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Side effects caused by the medications should be considered.
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Identification of risk of drug interaction and adverse risk medication.
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The person should know over-the-counter medications.
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The patient and the caregiver should be advised and educated regarding safe medication.
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The patient should be educated regarding the indication of every prescribed medication.
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Common side effects that may be expected should be reviewed.
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Ask the patient to fill every medication in the same pharmacy.
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Expired medications and medications that are no longer required should not be used. Self-medication, non-prescribed medicines, and herbal supplements should be avoided.
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How Can Polypharmacy Be Avoided?
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Proper discussion should be done with the patient and the caregiver to secure a proper list of medications:
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The list of medicines prescribed should be reorganized.
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Inappropriate medication or improper prescriptions should be eliminated.
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The doctor should be careful while removing a medication that is inappropriate or not needed anymore.
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Any potential issues should be monitored during the annual wellness examination.
What Are the Risk Factors Associated With Polypharmacy?
Some common risk factors are
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Drug interaction.
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Side effects caused by medication intake.
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Increase the risk of hip fracture.
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Inappropriate therapy.
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Usage of over-the-counter medication.
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Alteration in pharmacokinetics related to aging.
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Transition of medical care.
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Poor physician-physician interaction.
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Increased age of the person.
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Poor self-reported health.
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Females.
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Many chronic conditions.
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Self-medication or inappropriate medication.
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Usage of many pharmacies.
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Increased patient workload.
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Lack of patient education.
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Multiple prescriptions.
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Poor doctor-patient interaction.
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No proper medicine reconciliation.
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Multiple electronic medical records.
What Are the Benefits of Effective Management of Patients?
Some benefits are
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Polypharmacy can be prevented.
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Enhanced health safety.
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Reduced hospitalization.
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Reduced cost of treatment.
Conclusion
Polypharmacy is a condition where the patient takes many inappropriate medications, usually for five medications. This usually affects older adults. Proper prescription of the medication required for the treatment of the condition and elimination of unwanted medication can help prevent polypharmacy. There should be proper monitoring of the patient taking many medications and regular medication reconciliation at every doctor visit.
