Introduction
Multiple chronic diseases and polypharmacy pose a challenge to the patients and healthcare systems. It requires early detection of diseases and decision-making by a multidisciplinary healthcare team to achieve the treatment goals and prevent side effects. The World Health Organization (WHO) suggests that evidence-based practice must be emphasized, and the goal of the treatment must also reduce the inappropriate use of polypharmacy.
What Is Polypharmacy?
Polypharmacy refers to the simultaneous use of five or more medications that are prescribed for various health conditions in an individual. The use of polypharmacy is mostly seen in the geriatric population due to multiple chronic conditions. Various studies suggest that elderly people consume significantly more medications than younger adults.
What Are Some of the Common Chronic Conditions Affecting Older Adults?
Multiple chronic conditions are the presence of two or more long-term diseases, which is especially seen in the geriatric population.
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These include musculoskeletal diseases associated with chronic pain, mental illness, joint and bone disorders, sensory deprivation such as impaired vision and hearing, cardiovascular diseases, metabolic diseases, etc.
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In recent years, elderly people are commonly associated with diseases such as diabetes, hypertension, arthritis (swelling of joints), osteoporosis (low bone density), inflammatory bowel disease, low immunity, hypercholesterolemia (high cholesterol levels), asthma, etc.
As a result, elderly people are prescribed various medications to help them manage the symptoms of these disorders and improve their quality of life.
Some commonly prescribed drugs in geriatric people include anti-diabetic agents, antiplatelets, nonsteroidal anti-inflammatory drugs (NSAIDs), antipsychotics, diuretics, etc. Certain commonly prescribed medications in elderly people may cause gait and balance issues, constipation, delirium (confusion), dry mouth, reduced cognition (reasoning), etc. Polypharmacy has been associated with a risk of fractures due to falls in older adults due to exposure to drugs related to nervous system disorders.
Physiological changes occur in elderly adults due to aging, which affects the absorption, distribution, metabolism, and excretion of drugs, increasing the risk of drug accumulation and complications. Studies indicate that geriatric people may not take approximately 50 percent of prescribed medications. It can be due to a lack of understanding of the use of medications, and lower socioeconomic status can also contribute to affecting the lifestyle of older people.
Elderly individuals dislike taking frequent medications due to fear of potential side effects, complex dosing regimens, altered taste perceptions, or due to media portrayal, etc. These factors may cause ineffective adherence to medicines, affecting the treatment.
How Can Polypharmacy Help in the Management of Multiple Chronic Conditions?
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Patient-centered or priority care must be available for such patients to guide appropriate decision-making and to provide immediate medical services during serious adverse effects. It is also known as medicine optimization for the safe and effective use of medicines and to ensure patients obtain the best possible outcomes from the treatment, along with a justifiable reason for the chronic use of certain medications.
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If the patient does not respond to certain medications for an adequate duration, the medicine can be replaced or discontinued to prevent potential harm, known as deprescribing medicines.
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Optimization of medications is especially important in older adults as they are more susceptible to anticholinergic adverse effects from some commonly prescribed medicines such as Cetirizine, Oxybutynin, Amitriptyline, Mirtazapine, etc.
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Over-the-counter drugs and herbal supplements taken by elderly people must be reviewed, evaluated, and verified for quality, safety, and efficacy.
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Various strategies, such as automatic pill dispensers, mobile applications, reminders through messages, and labels with pictograms, are being employed by hospitals and healthcare professionals for the effective use of polypharmacy.
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Following the general prescription principle of ‘start low and go slow’ must be employed to prevent potential drug interactions or side effects.
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Periodic monitoring of drugs and their dosages and evaluation of the risk-benefit ratio must be performed by doctors frequently to prevent the unnecessary burden of medications, loss of drug effect, or treatment failure. The risk assessment and a comprehensive review of medication can be done by screening or trigger tools, assessment review tools such as Beers, START (screening tool to alert to right treatment), STOPP (screening tool of older people’s prescriptions), etc., which help evaluate the cause and prevent medication errors in polypharmacy.
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Good communication, educating the patients and the caregivers about the drugs, dosage, schedule, periodic checkups, etc., plays an important role in the success of the treatment.
What Are the Drawbacks of Polypharmacy?
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Poor communication between healthcare professionals and patients or caregivers is known to be the most common reason for side effects in patients under polypharmacy.
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Polypharmacy is associated with drug interactions, poor adherence to medicines, increased risk of side effects, and a higher cost of treatment that might not be affordable by many elderly people.
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Studies suggest that polypharmacy may be associated with cognitive decline and higher chances of depression.
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Most elderly people may not tolerate polypharmacy, and it can cause excessive tiredness, sleep or drowsiness, weakness, hallucinations, confusion, anxiety, lack of interest, and anorexia (lack of appetite) in most patients affecting daily activities.
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Patients or caregivers may miss or alter the doses of certain medications or may consult multiple doctors, affecting the effectiveness of treatment.
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Drug interactions may occur as geriatric people are less involved during clinical trials, which may significantly affect their health.
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The use of self-medications such as herbal supplements or over-the-counter drugs (OTC) is commonly seen in geriatric people and may result in complications. It can be due to prior experience with the medicine, uncertainty of its safety, underestimating the disease, etc.
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The availability of newer medicines or health supplements and the curiosity of people about their use without proper consultation may lead to adverse effects.
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Polypharmacy may possess an increased risk for liver and renal disorders in older people.
Conclusion
Elderly people are associated with an increased risk of multiple chronic diseases, which can hamper their lifestyle. It is associated with impaired homeostasis and contributes to the necessity of polypharmacy. An age-friendly optimization of medications must be advised by healthcare professionals, along with a routine assessment of health, to achieve medicine adherence, appropriate treatment goals, and prevent complications.
