How does polypharmacy affect the elderly? What is polypharmacy? Polypharmacy is the when a patient is prescribed five or more drugs at the same time. Notice the part of the definition that says ‘or more’ because that tends to be the case in a lot of the elderly, especially with chronic diseases piling up. Many people believe polypharmacy is an effective solution to illness and that this will take care of everything by just prescribing a different medication for each side effect. I believe that after that many drugs at one time, it becomes unhealthy and dangerous to the patient consuming these medications, and it does not help when the healthcare team prescribing these medications is only making it worse for the patient with careless mistakes. Polypharmacy has negative effects because of, how it’s being misused, how the carelessness of the healthcare teams can make it worse, how it can be avoided, and what will happen if it continues to be mistreated. 

Polypharmacy is becoming increasingly popular in the elderly population as the years pass on. In one study “Harvard researchers reported in November that 39 percent of those over age 65 now use five or more medications — a 70 percent increase in polypharmacy over 12 years” (Span). Now that increase is not one that is beneficial to the elderly, just quite the opposite. 

There are many possible factors that could be contributing to the rising numbers. One possible reason is the “Medicare Part D drug coverage in 2006 and treatment guidelines that (controversially) call for greater use of statins” (Span). Now as that may be a contributing factor, a major issue is when the inclusion of dietary supplements is added into the mix (Span). Dietary supplements are vitamins and herbs commonly known as ‘over-the-counter’ drugs. Over-the-counter drugs are any medication you can get at the pharmacy without a prescription (Span). By themselves these drugs can be harmless, but when mixed with other drugs that are prescribed, they can produce costly negative health effects (Span). A common example of the negative effects of taking dietary supplements with prescription medications without knowing dangers is consuming the over-the-counter vitamin fish oil with a blood thinner like warfarin, this interaction would cause bleeding in the patient (Span).

 The reason the elderly are more prone to the dangers of polypharmacy is because they can start to acquire multiple chronic diseases increasing their pill intake and therefore increasing their overall chance of interactions. Another aspect of the dangers of polypharmacy in the elderly is when all these medications produce nasty side effects they have more harmful effects on the elderly. When the medications make them dizzy they don’t have the same strength or balance as the average human and are more prone to falling and hurting themselves (Span). Dr. Qato did a study on the effects of polypharmacy on the elderly. When he was interviewing someone, he asked why they didn’t tell the doctor of the other medications they were taking and their response was about as logical as it gets “No, why should I? If it was important, why didn’t he ask me?” (Span). So, this really raises the question of how much of polypharmacy can be avoided with a little attention from healthcare providers.

A study led by Dr. Qato published in JAMA Internal medicine was done and the results concluded that “Polypharmacy is responsible for 28 percent of all hospital admissions, and it is the fifth leading cause of death in the U.S.” (Brazier). Now that alone could be the argument that would prove that polypharmacy hurts more than it is beneficial. While there are some positive effects of polypharmacy if done correctly, it is mostly done inappropriately. Four points are presented when it comes to inappropriate polypharmacy “A patient continues taking drugs that are no longer needed, or at a dose that is no longer suitable. A drug is not achieving its therapeutic aim. The combination of therapies leads to adverse reactions or interactions. The patient does not follow the physician's instructions” (Brazier). Each of these points individually can produce negative effects in the elderly patients taking them, but many times more than one of those points are occurring at one time. Polypharmacy tends to affect the elderly more as stated earlier because they have more intricate needs. In the United States “People aged 65-69 years take an average of around 14 prescription drugs, rising to 18 by the time they are 80-84 years old” (Brazier). 

Some of the side effects of polypharmacy include “Loss of appetite, constipation, diarrhea, incontinence, tiredness, sleepiness, decreased alertness, confusion, hallucinations, falls, weakness, dizziness, depression, anxiety, excitability, and skin rashes” (Brazier). Obviously the more medications the elderly patient is taking the more prone they will be to having an interaction, study shows that “A patient taking between five and nine medications has a 50 percent chance of an adverse interaction, rising to 100 percent with 20 or more medications” (Brazier). Now this statistic may seem scary, but there are some things that would reduce the negative effects of polypharmacy. Setting up a system that will ultimately “Support the ongoing monitoring of drug use, ensure that drug combinations are reasonable, continuously assess the benefits and harms of the drugs being taken, and review patients' ongoing needs” (Brazier). This system would decrease the negative effects of polypharmacy tremendously but still could not completely eradicate them. 

Since “polypharmacy is a main issue of patient safety in all healthcare settings” (Arnoldo et al), a study was done to test how many elderly patients participated in polypharmacy and the prevalence in healthcare settings. The healthcare settings they tested were hospitals, general practitioners, and long term care facilities. They did a study on 1582 patients all 65 years and older. It was concluded that “patients in therapy with 10 drugs or more were 13.5%: 15.2% in hospitals, 9.7% in GPs’ clinics and 15.6% in LTCFs” (Arnoldo et al). Those numbers don’t seem to bad but you must remember that’s 10 or more drugs not the usual definition of 5 or more. The study also identified that “1152 PIPs that involved globally almost half of patients (46.0%): 41.9% in hospitals, 59.6% in LTCFs and 37.0% in GP’s clinics” (Arnoldo et al). A PIP is a potentially inappropriate prescription, so that means that almost half the patients had at least one medication that was inappropriate for them. Their study concluded that the long-term care facilities were remarkably more exposed to PIPs (6 out of 10 patients to be exact), which should not be the case since long term care facilities are designed to make the lives of the elderly significantly easier, not add one more thing to their list of things they have to worry about. If polypharmacy is already so dangerous, how much worse does it get when the healthcare providers can’t even prescribe the correct medications?

Adverse drug effects and interactions can be very dangerous, it is estimated that “25-50% of older patients have drug side effects” (Nair). Then on top of that about 25% of those adverse effects could be prevented. Whenever these elderly patients have these adverse side effects, there are “unnecessary hospital admissions, increasing healthcare cost and most importantly, reducing the patients’ quality of life” (Nair). all those issues are just part of a domino effect and it all starts with polypharmacy. As people age the risk factors for a lot of stuff increases and a major one is polypharmacy, these risk factors include “poor communication from doctors, cognition issues, deafness, poor eye sight, use of numerous over the counter medications and presence of multiple prescribers” (Nair). All those risk factors can present major problems to the patients, and they can’t even control half of them. The patients just have to trust the medical professionals like they should but they still end up getting in worse shape. The only way to make to help the issue is to have the healthcare professionals review all the patient’s medications and to take them off the medication if it is not necessary to be in their system. 

Drug interactions in the field of pharmacy are going to happen, it’s just part of it. However, with pharmacy the number of interactions is much higher. It was recorded that “Drug interactions reportedly account for up to 20% of adverse drug reactions and can lead to severe adverse drug events” (Ritsner 65). Most of these can be avoided, but are not due to careless mistakes. It was also recorded that “47.7% of avoidable adverse drug reactions were attributed to drug interactions with 67% reported as life threatening, permanently disabling or requiring transfer for medical care” (Ritsner 65-66). This means that elderly individuals who may already have a few chronic diseases could have their life put in danger or be permanently disabled just because an avoidable drug reaction occurred. There are many risk factors that can be accountable for drug interactions directly related to the patient or the drug itself.

These include “Patient factors such as age, number of drugs prescribed, and concomitant medical illnesses have all been shown to increase the risk of experiencing clinically significant adverse events secondary to a drug interaction. Age related changes in metabolism, excretion and drug sensitivities lead to increased rates of drug interactions in elderly patents. Studies have documented up to 25% of elderly patients experience clinically significant problems due to drug interactions” (Ritsner 66). 

As you can see, drug interactions increase with age which is why polypharmacy so negatively 

effects the elderly. When the number of drugs increase, so does the risk of a drug interaction, “82% of patients on seven drugs are at risk for a drug interaction” (Ritsner 66). What are some steps to reduce the likelihood of a drug interactions? The first step is simple, decrease the amount of drugs the patient is taking, therefore terminating polypharmacy the next step is “regular review of drugs and discontinuation of drugs with limited or questionable benefit” (Ritsner 67). Another crucial step would to have the prescriber write down a list of the “prescription, over the counter, illicit and herbal drugs and supplements” (Ritsner 67). That way if at all cost the patient has to participate in polypharmacy at least it’s done safely.

When it comes to these elderly patients who are considered to be included in the group of polypharmacy, you have to consider the benefits but what is the true quality of life when you have to take several pills several times a day that yes keep you functioning but produce horrible side effects and adverse reactions? This next study tested the quality of life in patients 65 years and older participating in polypharmacy. The results of the patients mainly included “functional incapacity, cognitive impairment and social and emotional problems were the main constraints to quality of life” (Montiel-Luque et al). From the quality of life test, the most reported factors that affected quality of life were anxiety, depression, and pain (Montiel-Luque et al). The factors that affected quality of life on the highest level was mobility and self-care (Montiel-Luque et al). the researcher’s solution to helping the cause of quality of life was to “focus on the development of social and health strategies to enhance their maximum functional capacity and mental health, correct situations of social risk, and avoid the use of multiple medications” (Montiel-Luque et al). 

Quality of life is determined by the rates of morbidity and mortality means no life at all. The morbidity and mortality rates of elderly patients will usually decide how often polypharmacy is used. The “increased morbidity and mortality” (Yuruyen et al) rates are directly resulting from polypharmacy. This is because when these patients are subject to diseases or close to death, several medications are just given to them for every single side effect they have regardless of the new side effects those medications are producing. For example, if an elderly patient goes to the doctor because they are having nasty side effects from one medication, instead of reviewing the medication and looking for a better alternative the doctor will just prescribe another medication to get rid of the side effects of the previous one. But what happens when this new medication produces a whole new set of side effects. This is why polypharmacy is dangerous because the doctor can legally just keep putting a band aid on the issue but just makes it worse instead of helping the elderly patient.

 With this cause and effect sequence increasing polypharmacy in elderly patients there are a couple of solutions to reducing the amount of medications a patient is taking or prescribing the best medication for that patient with the least negative effects. The first thing the elderly patient can do is take all their medications in to their local pharmacy and do what’s called a ‘brown bag review’, the pharmacist reviews all the medications and makes sure everything is correct and everything the elderly patient is taking is necessary. It is also beneficial to the elderly to go to the least amount of health care professionals as possible to reduce the risk of the same medication being prescribed twice. This shouldn’t be an issue but it is, because a doctor has the ability to look up the patients’ medical records to see what they are currently prescribed. 

Even though polypharmacy produces many side effects, many doctors argue it is the best method when handling elderly patients with chronic diseases. Many doctors believe polypharmacy is essential and beneficial to the elderly who have a couple chronic diseases because it is necessary to put all the drugs for those diseases together to heal the patient. They believe they are not prescribing anything wrong everything for their patients is safe and the most efficient way to keep the healthy and to cure them. The researcher from one study said that the “combined use of three or more drugs is beneficial and appropriate” (Aronson). The examples he gave that this was necessary for was dangerous auto immune diseases like HIV and AIDS. 

In conclusion, it should be very clear that polypharmacy has negative effects on the elderly. There are several cons to prove that it is not beneficial to prescribe so many pills to the elderly even if they have chronic diseases. When this happens, it produces many drug interactions that can be anything from minor side effects to very dangerous adverse drug effects. As previously stated, it can lead to permanent disabilities and even death in some cases. Polypharmacy just continues to increase especially since the baby boomers are starting to reach their elder years. So, the issue of polypharmacy is just going to continue to rise unless healthcare workers can really buckle up and make sure each one of their patients are taking the correct amount and type of medications. Because if no health care workers try and reduce the negative effects of polypharmacy it is just going to increase more as the years pass and is just going to become more dangerous to the elderly patients who are just doing what each one of their prescribers are telling them to do. Just think about your grandparents or parents or even yourself because eventually polypharmacy could be an issue in your life and you need to know how to make sure to keep yourself or loved ones as healthy as possible.
