Posted by: Gina Salamone
Polypharmacy is the concurrent use of multiple medications, usually five or more, and is prevalent in the elderly American population. The more medications a person takes, the higher the risk of dangerous drug-drug interactions and an increased possibility of inappropriate prescribing, adverse drug reactions, lower adherence to drug regimens, hospitalization, and even death. While many medications can help control disease and conditions such as arthritis, diabetes, high blood pressure, osteoporosis, heart disease, and more, the US societal dependency on pharmaceuticals is both a nod to Western medicine’s success and problematic when polypharmacy arises.
A University of Michigan study on healthy aging finds that 2 in 5 adults (ages 50-80) take 2 to 4 prescription medications while 23% take 5 or more. And over half of older Americans, 52%, take 2 or more non-prescription drugs. Each new drug increases the chance of side effects and interactions. Doctors who overprescribe medications will even prescribe a new medicine to treat the side effects of another.
To limit polypharmacy’s negative effects, older patients must have a comprehensive medication review (CMR). The purpose of the evaluation is to have a doctor or pharmacist evaluate all the medications you take. A CMR appointment must be scheduled specifically as most medical offices slot appointments in 15-minute increments, which is too short to review several medications. A full list, including non-prescription drugs, is essential for a comprehensive medication review. If that seems a complex task, bring in all of your pill bottles, including dietary supplements and other over-the-counter medicines. Be certain to address lifestyle choices such as smoking or alcohol use and medical and recreational marijuana. All of these substances alone or in combination can create adverse effects or amplify the effects of medication.
Beyond the number of medications, doctors need to be wary of dosages in the elderly. Older bodies process medications differently as the digestive system, kidneys, and liver are operating less efficiently. A drug may stay present in the body longer, requiring a more conservative dosage. A study by the Journal of the American Geriatrics Society notes that as many as one-third of seniors take medicines unsuitable for their age category. It is best to retain a medical doctor who specializes in the treatment of older individuals or geriatrics.
The National Institute on Aging has recently updated its guide to medicine safety for older adults addressing a range of topics and questions to ask your doctor about a new or existing prescription. It is generally safer to use just one pharmacy. A single pharmacy allows a pharmacist to see your entire prescription list and protect against known adverse drug reactions.
Be alert for side effects on your own. Read the accompanying drug literature and take the proper dosage at the prescribed time and with food if instructed. Note if there are differences in your memory, balance, or other changes that affect your emotional, cognitive or physical being. A list of some common adverse effects caused by multiple medications can include, but are not limited to:
- Decreased alertness, drowsiness, or sleepiness
- Diarrhea, incontinence, or constipation
- Loss of appetite
- Confusion that is either episodic or continuous
- Mobility issues or falls
- General apathy or depression
- Hallucinations like hearing or seeing things
- Excitability, irritability, or anxiety
- Changes in sexual behavior
- Skin rashes or breakouts
Polypharmacy can bring about a host of undesirable and potentially dangerous side effects, particularly in older adults. As the number of medications increase, so too does the risk of untoward effects. Any offsets to physical challenges or disease that a healthier lifestyle can address is one of the surest ways to lower the number of your prescribed medications. A comprehensive medication review is the starting point for evaluating what can be made better by being more physically active, a non-smoker and moderate alcohol drinker, a healthy diet, and getting adequate sleep duration, thus potentially removing a medication. It is never too late to reap some benefits of adopting a healthier lifestyle, and it might just keep you from the dangers that present themselves in polypharmacy.
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