What are four age-related effects of polypharmacy?

According to a JAMA analysis, over 4 out of 10 adults aged 65 or older used five or more prescription medications between 2017 and 2020, demonstrating a concerning rise in the practice. This trend, known as polypharmacy, has several significant age-related effects that can jeopardize senior health and well-being.

Quick Summary

Four age-related effects of polypharmacy include increased cognitive decline and confusion, a higher risk of falls and related fractures, nutritional deficiencies caused by appetite changes or malabsorption, and a greater likelihood of adverse drug events and interactions.

Key Points

• Cognitive Risks: Polypharmacy can significantly increase the risk of cognitive decline, memory issues, and delirium in older adults.

• Fall Hazard: The combined effects of multiple medications often lead to dizziness and instability, dramatically raising the risk of falls and fractures.

• Nutritional Impact: Multiple drugs can suppress appetite or interfere with nutrient absorption, contributing to malnutrition and affecting overall health.

• Adverse Events: The more medications taken, the higher the risk of adverse drug events (ADEs) and dangerous drug-drug interactions.

• Deprescribing is Key: Systematically reviewing and, where appropriate, discontinuing unnecessary medications is a crucial strategy for mitigating polypharmacy risks.

• Collaborative Care: Optimal management involves a team-based approach, including the patient, family, doctors, and pharmacists, to ensure medication safety.

Understanding Polypharmacy in Seniors

Polypharmacy is the regular use of multiple medications, typically defined as five or more, often to manage multiple chronic conditions. While necessary for many, this practice carries heightened risks for older adults due to age-related physiological changes that alter how drugs are absorbed, metabolized, and eliminated. These changes can cause medications to accumulate in the body, increasing the risk of adverse effects. As the number of medications grows, so does the complexity of the regimen, posing significant health challenges for the aging population.

Four Age-Related Effects of Polypharmacy

1. Increased Cognitive Impairment

Polypharmacy is significantly associated with an increased risk of cognitive decline, mild cognitive impairment (MCI), and dementia in older adults. The combination of multiple medications, especially those affecting the central nervous system, can cause confusion, memory loss, and delirium. Certain drug classes are particularly implicated, such as anticholinergics and sedatives, which interfere with neurotransmitter function and can worsen cognitive performance. A prescribing cascade, where a new drug is prescribed to treat a side effect of another, can also perpetuate and exacerbate cognitive issues. Regular monitoring is essential to distinguish between symptoms of a new condition and side effects from medication.

2. Higher Risk of Falls and Fractures

Falls are a leading cause of injury and mortality in the elderly, and polypharmacy is a well-established risk factor. Adverse effects like dizziness, lightheadedness, balance problems, and sedation increase the likelihood of a fall. Specific medications are known as “fall risk-increasing drugs,” including benzodiazepines, antidepressants, and blood pressure medications. A fall can lead to serious injuries, most notably hip fractures, which are also linked to polypharmacy. The complex interaction of multiple drugs, combined with age-related changes in gait and balance, creates a dangerous situation that can severely impact an older adult’s independence and quality of life.

3. Nutritional Deficiencies and Malnutrition

Taking multiple medications can negatively impact an older adult's nutritional status through various mechanisms. Many drugs can cause side effects like anorexia, nausea, and vomiting, which decrease food intake. Other medications can alter the sensory perception of taste, further reducing appetite. Furthermore, some medications interfere with the absorption, metabolism, and excretion of essential vitamins and minerals. For instance, proton pump inhibitors can affect B12 and magnesium absorption, while metformin can lower B12 levels. A compromised nutritional status can, in turn, affect how drugs work in the body, creating a vicious cycle. A prospective study highlighted this issue, finding that 50% of those taking 10 or more medications were at risk of malnourishment.

4. Increased Adverse Drug Events and Interactions

Adverse drug events (ADEs) and drug-drug interactions (DDIs) are a direct consequence of polypharmacy and a major reason for hospital admissions among older adults. With each additional medication, the probability of a harmful interaction increases. Older adults are particularly vulnerable because of age-related declines in kidney and liver function, which slows drug clearance and increases the risk of drug accumulation and toxicity. This can lead to a variety of severe outcomes, including neuropsychological events like delirium, acute renal failure, and hypotension. The issue is further compounded when patients also use over-the-counter medications, supplements, or herbal remedies that can interact with their prescriptions without their doctors' knowledge.

Mitigating the Risks of Polypharmacy

Managing polypharmacy requires a proactive and comprehensive approach involving patients, caregivers, and a multidisciplinary healthcare team. The process of “deprescribing” can help identify and discontinue medications that are no longer necessary or whose risks outweigh their benefits.

Steps for Managing Polypharmacy

1. Conduct Regular Medication Reviews: During every clinical visit, bring a list of all medications, including prescriptions, OTCs, and supplements. A healthcare provider can review each one to ensure it is still necessary and effective.
2. Use Screening Tools: Doctors can use tools like the Beers Criteria to identify potentially inappropriate medications for older adults.
3. Simplify the Regimen: Healthcare providers should aim to reduce the number of medications and simplify dosing schedules to improve adherence and reduce confusion.
4. Explore Non-pharmacological Alternatives: For minor symptoms, non-drug interventions like physical therapy, dietary changes, or cognitive behavioral therapy may be more appropriate.
5. Watch for Prescribing Cascades: Be aware of new symptoms and question whether they are a side effect of an existing medication rather than a new condition requiring another drug.

Polypharmacy vs. Controlled Medication Management

Aspect	Unmanaged Polypharmacy	Controlled Medication Management
Adverse Drug Events	High risk due to drug interactions and increased toxicity.	Minimized risk through regular reviews and deprescribing.
Cognitive Health	Increased confusion, delirium, and risk of cognitive decline.	Improved mental clarity and reduced risk of cognitive impairment.
Physical Function	High risk of falls, frailty, and functional decline.	Enhanced mobility, balance, and physical independence.
Nutritional Status	Higher risk of anorexia, malabsorption, and malnutrition.	Better appetite and improved nutritional intake and absorption.
Healthcare Costs	Higher due to increased hospitalizations, emergency room visits, and numerous prescriptions.	Lowered costs through reduced hospital visits and deprescribing unnecessary drugs.
Quality of Life	Diminished due to debilitating side effects and complex regimens.	Improved overall well-being and independence.

Conclusion

Understanding what are four age-related effects of polypharmacy is crucial for protecting the health of older adults. The increased risks of cognitive decline, falls, malnutrition, and adverse drug events are not inevitable consequences of aging but rather treatable and preventable complications of unmanaged medication use. By engaging in open communication with healthcare providers, proactively reviewing medication lists, and implementing smart management strategies, seniors and their caregivers can significantly reduce these risks. Prioritizing medication safety is a vital step toward promoting healthy and vibrant aging. For additional guidance, consider resources like those provided by the National Institutes of Health(https://www.ncbi.nlm.nih.gov/books/NBK574575/).

Frequently Asked Questions

What is considered polypharmacy?

Polypharmacy is generally defined as the regular use of five or more medications simultaneously. However, even taking fewer than five medications can be considered polypharmacy if the drugs are high-risk or inappropriate for an older adult.

Why are seniors more susceptible to polypharmacy's effects?

Older adults have age-related physiological changes that affect how their bodies process medications. Decreased kidney and liver function can lead to drug accumulation, increasing the risk of adverse effects and interactions.

What are some early signs of a polypharmacy problem?

Watch for symptoms such as new or increased confusion, frequent dizziness, unexplained falls, loss of appetite, or an increase in the number of hospitalizations. These can indicate an adverse drug effect.

What can I do if I suspect polypharmacy is affecting my loved one?

The most important step is to schedule a comprehensive medication review with their primary care physician or a geriatric pharmacist. Bring all medications, including prescriptions, OTCs, and supplements, to the appointment for a thorough evaluation.

What is deprescribing?

Deprescribing is the systematic process of reducing or stopping medications that may be causing harm or are no longer beneficial. This is done with careful planning and monitoring by a healthcare professional.

Can over-the-counter drugs and supplements cause polypharmacy issues?

Yes. Many OTC medications, supplements, and herbal remedies can interact with prescription drugs, increasing the risk of adverse effects. It is vital to include all of these in any medication review.

Are all cases of polypharmacy bad?

No. While often viewed negatively, polypharmacy can be appropriate and necessary for a patient with multiple chronic conditions. The key is ensuring the medication use is appropriate, safe, and regularly reviewed.