Polypharmacy describes the use of multiple medications at the same time by a single individual, commonly defined as the regular use of five or more medicines. This situation is widespread among older adults, with some studies indicating that 44% of people aged 65 and older use five or more medications. It is also prevalent among people with multiple long-term health issues, known as multimorbidity, as the number of medications taken tends to increase with age and complex health conditions.
Causes of Polypharmacy
The primary driver of polypharmacy is the presence of multiple chronic conditions. As individuals age, they are more likely to develop several long-term health problems, such as heart disease or diabetes, each managed with specific drugs. This accumulation of prescriptions for different ailments leads to taking many medications simultaneously.
Patients often see multiple specialists, such as a cardiologist and an endocrinologist, who may prescribe medications without full awareness of the patient’s complete medication list. This lack of coordinated care, combined with poorly updated medical records or automated refills, can lead to an unintentional increase in prescriptions. These factors make it difficult to track all the medications a person is taking.
Another factor is the “prescribing cascade.” This occurs when a drug’s side effect is misinterpreted as a new medical condition, leading a provider to prescribe another medication to treat that symptom. For instance, a medication for high blood pressure can cause swelling in the legs. If this is mistaken for a new problem, a doctor might prescribe a diuretic, which introduces its own potential side effects and interactions.
Health Risks Associated with Multiple Medications
Taking numerous medications elevates the chance of adverse drug events (ADEs), which are injuries from drug use ranging from minor side effects to severe reactions. For older adults, age-related changes like reduced kidney and liver function alter how their bodies process medications, making them more susceptible. Common side effects like dizziness, confusion, and sedation can be magnified when multiple drugs are taken together.
A primary concern is the increased probability of harmful drug-drug interactions. When multiple drugs are present, one can alter the effects of another, making it less effective or more toxic. For example, some antibiotics may not be properly absorbed if taken with supplements containing calcium or iron. The risk of such interactions grows with each additional medication.
Polypharmacy is linked to a higher risk of specific health issues, especially in the elderly. These include an increased likelihood of falls, which can lead to serious injuries, and cognitive impairment, including memory problems. Managing a complex medication schedule can also be challenging, leading to non-adherence. Patients may miss doses or take the wrong amount, worsening their health conditions, and the financial strain of numerous prescriptions can be a further barrier.
Managing and Reducing Polypharmacy
A primary strategy for managing polypharmacy is “deprescribing.” This is the planned and supervised process of stopping or reducing the dosage of medications that may be causing harm or are no longer beneficial. Deprescribing is a positive therapeutic step aimed at reducing the overall medication burden and improving a person’s quality of life.
Deprescribing is centered around regular medication reviews, conducted by a primary care physician or a clinical pharmacist. These reviews involve a comprehensive assessment of all medications a person is taking, including prescriptions, over-the-counter products, and supplements. The goal is to identify unnecessary medications, therapeutic duplication, and potential interactions.
Patients and caregivers can take active steps to manage medications safely. Keeping a detailed and current list of all medications to bring to every medical appointment is a fundamental step. This ensures all providers have accurate information. Using a single pharmacy for all prescriptions also helps, as pharmacists can more easily spot potential interactions or duplicate therapies.
When visiting a doctor, ask direct questions about each medication, such as “Is this medicine still necessary?” or “Could any of my symptoms be a side effect of my medications?” These questions can open a conversation about the possibility of deprescribing. This collaborative approach helps align treatment plans with the patient’s current health goals.