The Rising Prevalence of Polypharmacy
Polypharmacy, typically defined as the regular use of five or more medications, has become increasingly common among older adults. A study in JAMA Internal Medicine revealed that between 2017 and 2020, more than 4 out of 10 adults aged 65 or older used five or more prescription medications in the past 30 days. This represents a significant increase over the last two decades, tripling the rate from twenty years prior. Even more concerning is the rise in “hyper-polypharmacy,” or the use of ten or more medications, affecting a substantial portion of the senior population. This upward trend is driven by several factors, including the increasing prevalence of chronic conditions and evolving treatment guidelines.
Why are older adults taking more medications?
Several factors contribute to the high and rising number of medications taken by older adults:
- Multimorbidity: As people age, they are more likely to develop multiple chronic health conditions simultaneously, such as high blood pressure, diabetes, heart disease, and arthritis. Managing these conditions often requires a complex regimen of multiple prescriptions.
- Specialized Care: Older adults often see multiple specialists, each prescribing medication for a specific condition without full awareness of the patient's entire medication list. This can lead to duplications and harmful drug interactions.
- Prescribing Cascade: This occurs when a new medication is prescribed to treat the side effects of an existing medication, leading to a chain reaction of unnecessary drug additions. For instance, a drug might cause dizziness, and a new medication is prescribed for the dizziness instead of adjusting the original drug.
- Age-Related Physiological Changes: The aging process affects how the body absorbs, metabolizes, and eliminates drugs. Slower kidney and liver function can increase the potency of medications, meaning doses that were appropriate in the past may become too high and cause adverse effects.
- Non-Prescription Drug Use: Many older adults also take over-the-counter (OTC) medications, vitamins, and supplements, which can interact with prescribed drugs and further complicate their regimen.
The Serious Risks Associated with Polypharmacy
Taking multiple medications, especially when not carefully managed, carries a host of risks for older adults. The dangers can range from mild side effects to life-threatening complications.
Common risks of polypharmacy:
- Increased Risk of Falls: Many medications, including those for anxiety, sleep, and blood pressure, can cause dizziness, drowsiness, and unsteadiness, leading to a higher risk of falls and related injuries.
- Adverse Drug Events (ADEs): The more drugs a person takes, the higher the likelihood of an ADE. Symptoms can include confusion, delirium, nausea, and changes in appetite.
- Cognitive Impairment: Certain medications or combinations can cause confusion, memory problems, and other cognitive issues, which are sometimes mistakenly attributed to dementia.
- Drug Interactions: One medication can alter the effectiveness of another. This can either reduce its intended benefit or increase the risk of toxicity.
- Hospitalizations: Medication-related problems, often due to polypharmacy, account for a significant percentage of hospital admissions for older adults.
- Poor Adherence: Managing a complex medication schedule can be overwhelming, leading to missed doses or incorrect timing, which undermines treatment effectiveness.
Comparison of Risks and Management Strategies
| Risk | |
|---|---|
| Drug-drug interactions | One medication may interfere with the effectiveness or increase the toxicity of another. |
| Side effects | Increased likelihood and severity of side effects such as dizziness, sedation, or confusion. |
| Falls | Medications affecting balance and blood pressure can lead to dangerous falls. |
| Cognitive Decline | Certain drug combinations can worsen memory and cause delirium. |
| Adverse Drug Events | Higher number of medications increases the risk of negative reactions. |
| Higher costs | More medications lead to higher out-of-pocket expenses and healthcare costs. |
| Poor adherence | Complex regimens can be confusing, causing missed doses or incorrect usage. |
| Strategy | |
|---|---|
| Regular medication review | Annually or more often, review all medications with a doctor or pharmacist to identify unnecessary or inappropriate drugs. |
| Use one pharmacy | Consolidating prescriptions at a single pharmacy allows the pharmacist to check for potential drug interactions. |
| Pill organizers | Using a pillbox or automated dispenser can help manage daily routines and reduce missed doses. |
| Create a complete list | Keep an up-to-date list of all prescriptions, OTC drugs, and supplements to share with every healthcare provider. |
| Monitor symptoms | Be vigilant for new or unusual symptoms that could indicate a side effect or interaction. |
| Deprescribing | A collaborative process with a doctor to reduce or stop medications that may no longer be beneficial or are causing harm. Read more from the Lown Institute here: Medication Overload and Older Americans. |
| Open communication | Talk to your doctor about all health changes, concerns, and supplements you take. |
Actionable Steps for Seniors and Caregivers
Managing multiple medications effectively requires proactive steps from both older adults and their caregivers. An annual comprehensive medication review with a healthcare provider or pharmacist is one of the most effective strategies. This review should cover all medications, including OTC drugs and supplements, to ensure they are still necessary and appropriate. Leveraging tools like pill organizers, medication reminder apps, or automated dispensers can simplify complex schedules and improve adherence. Furthermore, it's vital to educate older adults on their medication regimen and empower them to ask questions and report any unusual symptoms. Open communication among multiple doctors and the pharmacy is a cornerstone of preventing medication-related problems. By following these strategies, older adults can minimize risks and maintain a safer, healthier lifestyle.
Conclusion
The average number of medications taken by older adults continues to rise, reflecting the complexity of managing age-related health conditions. While medication is essential for treating chronic diseases, the increasing prevalence of polypharmacy demands careful attention due to its associated risks. Awareness of the problem and the implementation of proactive management strategies—such as regular medication reviews, consistent communication with healthcare providers, and using medication organization tools—are critical steps toward ensuring the safety and well-being of older adults. Addressing polypharmacy is not just about counting pills; it is about promoting healthy aging and improving quality of life.
