What is it called when elderly are at risk for taking many medications together?: An Overview of Polypharmacy

According to a Centers for Disease Control and Prevention report, about one-third of American adults aged 60-79 use five or more prescription drugs regularly. This widespread practice, with its associated risks, is the answer to what is it called when elderly are at risk for taking many medications together.

Quick Summary

Polypharmacy is the term used to describe the use of multiple medications, which is a major health concern for older adults. This practice, often a result of managing multiple chronic conditions, significantly increases the risk of dangerous drug-drug interactions and adverse side effects.

Key Points

• Polypharmacy is Common: The regular use of multiple medications, often defined as five or more, is prevalent in older adults due to multiple chronic conditions.

• Increased Risk with Age: Age-related changes in metabolism and body composition increase the risk of adverse drug events and interactions in the elderly.

• Dangers Include Falls and Cognitive Decline: Inappropriate polypharmacy is a significant risk factor for falls, cognitive impairment, and hospitalizations.

• The 'Prescribing Cascade' Threat: A common hazard where a new drug is prescribed to treat side effects from an existing one, compounding the problem.

• Regular Review is Crucial: Regular medication reviews with healthcare professionals are essential for identifying and addressing potentially unnecessary or harmful drugs.

• Deprescribing is a Key Strategy: Safely and systematically reducing or discontinuing unnecessary medications can improve patient safety and health outcomes.

• Communication is Vital: Open communication with doctors, pharmacists, and caregivers is the foundation of safe medication management for older adults.

Defining Polypharmacy: A Multifaceted Problem

While a common quantitative definition for polypharmacy is the concurrent use of five or more medications, its true meaning goes beyond a simple number. Some experts prefer a qualitative definition, focusing on the use of any medication that is clinically inappropriate, unnecessary, or fails to achieve therapeutic goals. It is crucial to understand that polypharmacy can be appropriate if each medication is prescribed for a clear therapeutic objective and the benefits outweigh the risks, particularly for individuals with multiple complex health issues. However, the risk of harm escalates exponentially with each additional medication.

Why Polypharmacy is a Concern for Older Adults

Older adults are uniquely vulnerable to the risks of polypharmacy due to age-related physiological changes. As people age, their bodies process medications differently. Factors contributing to this include:

• Changes in Metabolism: The liver's efficiency in breaking down drugs and the kidneys' ability to clear them from the body decline with age, leading to drugs lingering longer in the system and accumulating to potentially toxic levels.
• Altered Body Composition: Older adults have a different proportion of fat to muscle mass and less total body water. This affects how drugs are distributed throughout the body, altering their concentrations and effects.
• Increased Sensitivity: The brain and other organs can become more sensitive to medications over time, especially to those affecting the central nervous system, which increases the risk of side effects like confusion, dizziness, and sedation.
• Multimorbidity: The coexistence of multiple chronic health conditions, such as heart disease, diabetes, and arthritis, necessitates multiple medications. This complexity makes safe medication management a significant challenge for both patients and healthcare providers.

The Dangerous Consequences of Polypharmacy

The potential negative outcomes of inappropriate polypharmacy are extensive and serious, impacting an older adult's overall health and quality of life.

Adverse Drug Events (ADEs)

ADEs are injuries resulting from drug use and are a major concern with polypharmacy. These can range from mild side effects to severe, life-threatening reactions. In older adults, ADEs can manifest as confusion, falls, depression, and gastrointestinal issues, which are often mistakenly attributed to normal aging or a new medical condition.

Increased Risk of Falls

Many medications commonly used by older adults, such as sedatives, antidepressants, and blood pressure medications, can cause dizziness, drowsiness, and impaired balance. When combined, the risk of falls and related injuries, like hip fractures, increases dramatically.

Cognitive Impairment

Polypharmacy is a known risk factor for cognitive decline, including memory loss, delirium, and dementia. Medications with anticholinergic properties, for example, can contribute to significant cognitive and psychological side effects.

The Prescribing Cascade

A particularly insidious consequence of polypharmacy is the prescribing cascade. This occurs when an adverse drug reaction is misinterpreted as a new medical condition, and a second medication is prescribed to treat it. This can lead to a vicious cycle of adding more medications to address the side effects of others, increasing complexity and risk.

Managing and Preventing Inappropriate Polypharmacy

Combating inappropriate polypharmacy requires a proactive, team-based approach involving the patient, family, and a network of healthcare professionals.

Strategies to Minimize Risk

1. Maintain an Accurate Medication List: Always have a current, complete list of all medications, including prescriptions, over-the-counter drugs, and supplements. Share this list with every doctor and pharmacist.
2. Regular Medication Review: Request a comprehensive medication review with a healthcare provider or pharmacist at least once a year. This check-up can identify unnecessary medications, duplicates, and potentially harmful combinations.
3. Encourage Open Communication: Be open and honest with healthcare providers about all medications and any side effects experienced. Don't hesitate to ask questions about why each medication is necessary and what the expected benefits and risks are.
4. Consider Deprescribing: This is the process of safely and systematically reducing or stopping medications when the harms outweigh the benefits, which is a key strategy for managing complex regimens. This should always be done under a doctor's supervision.

Appropriate vs. Inappropriate Polypharmacy: A Comparison

Aspect	Appropriate Polypharmacy	Inappropriate Polypharmacy
Justification	All medications are clinically indicated and aligned with the patient's therapeutic goals and preferences.	Medications are unnecessary, potentially harmful, or fail to achieve therapeutic objectives.
Risk vs. Benefit	Benefits of the medication regimen clearly outweigh the risks.	Risks of side effects, drug interactions, and other adverse events outweigh potential benefits.
Regimen Complexity	Optimized for the simplest possible dosing schedule to maximize adherence.	Unnecessarily complex, confusing, and difficult for the patient to follow correctly.
Monitoring	Regular, ongoing monitoring by a healthcare team to ensure the regimen remains safe and effective.	Insufficient review or oversight, leading to unchecked adverse effects and drug interactions.
Outcomes	Leads to better management of chronic conditions and improved quality of life.	Increases the risk of hospitalizations, falls, cognitive decline, and other negative health outcomes.

Conclusion: A Path to Safer Medication Management

Polypharmacy in the elderly is a serious and complex issue that can have profound consequences for health and well-being. By understanding the causes and risks, and by actively engaging in medication management with healthcare providers, older adults and their caregivers can work to prevent inappropriate polypharmacy. Regular reviews, open communication, and the intentional process of deprescribing are vital tools for ensuring a safer and healthier aging process. For additional guidance, the National Institute on Aging provides valuable resources on managing medications and avoiding the dangers of polypharmacy.

Frequently Asked Questions

What is the primary term for when elderly are at risk for taking many medications together?

The primary term for when elderly individuals are at risk for taking many medications together is polypharmacy. This refers to the concurrent use of multiple drugs, which can be appropriate or inappropriate, depending on the clinical context.

How many medications typically define polypharmacy?

While the definition can vary, polypharmacy is most commonly defined as the regular use of five or more medications, including prescription, over-the-counter, and even herbal supplements.

What are the biggest risks associated with polypharmacy in older adults?

The biggest risks include adverse drug events (ADEs), dangerous drug-drug interactions, increased risk of falls and fractures, cognitive impairment (such as confusion and delirium), and higher rates of hospitalization.

What is a 'prescribing cascade' and how does it relate to polypharmacy?

A prescribing cascade is a dangerous cycle where a new medication is prescribed to treat a side effect of another medication, mistakenly interpreting the side effect as a new health condition. This directly contributes to polypharmacy by increasing the number of drugs taken.

How can an older adult or their caregiver identify potential polypharmacy issues?

Signs of potential polypharmacy issues include unexplained symptoms like dizziness, confusion, nausea, or falls. A good strategy is to bring all medications, including supplements, to every doctor's appointment for review.

What is 'deprescribing' and is it safe?

Deprescribing is the process of identifying and discontinuing medications when the risks outweigh the benefits. When done systematically and under the supervision of a healthcare professional, it is a safe and effective way to reduce the dangers of polypharmacy.

Who should be involved in managing polypharmacy?

Effective management of polypharmacy requires a team approach. The patient, their family members, primary care physicians, specialists, and pharmacists all play a crucial role in regularly reviewing and optimizing medication regimens.