What is it called when people are on multiple medications at once which might cause symptoms that look like an NCD?

According to the World Health Organization, non-communicable diseases (NCDs) are responsible for a large percentage of deaths globally. But what is it called when people are on multiple medications at once which might cause symptoms that look like an NCD? This phenomenon is known as polypharmacy, and it's a critical issue in senior care that requires careful management.

Quick Summary

Polypharmacy is the term for taking multiple medications simultaneously, often defined as five or more. This practice can cause a cascade of adverse drug effects that mimic the symptoms of a non-communicable disease (NCD), such as cognitive impairment or physical frailty, making proper diagnosis challenging.

Key Points

• Polypharmacy Defined: The term for taking multiple medications simultaneously, often considered five or more, which is particularly common among seniors with multiple chronic conditions.

• Prescribing Cascade: This refers to the dangerous cycle where a new medication is prescribed to treat the side effects of an existing drug, mistaking them for new health conditions.

• Mimicking NCD Symptoms: Polypharmacy can cause symptoms like cognitive impairment, confusion, dizziness, and fatigue that are often misinterpreted as non-communicable diseases or normal aging.

• Risks for Seniors: Older adults are at a higher risk due to age-related physiological changes that affect how their bodies process and eliminate medications, increasing the potential for adverse drug effects.

• Importance of Medication Management: Regular, comprehensive medication reviews involving patients, caregivers, and healthcare providers are essential to prevent and manage the negative consequences of polypharmacy.

• Distinguishing Symptoms: A careful assessment of when new symptoms appear relative to medication changes can help differentiate between polypharmacy effects and an underlying disease.

Understanding Polypharmacy and Its Risks

Polypharmacy refers to the use of multiple medications by a single individual, a common occurrence, particularly among older adults. Taking many medications increases the risk of adverse drug effects, drug-drug interactions, and the prescribing cascade. Older adults face higher risks due to age-related changes affecting drug processing and elimination, potentially leading to medication accumulation and adverse events.

The Prescribing Cascade: A Dangerous Cycle

The prescribing cascade is a situation where a new symptom is incorrectly attributed to a new medical condition instead of being recognized as a side effect of an existing medication. This can lead to the prescription of additional medications, creating a cycle that increases the number of drugs taken and complicates the clinical picture.

Symptoms Mimicking Non-Communicable Diseases

Symptoms of polypharmacy can closely resemble those of Non-Communicable Diseases (NCDs), posing a challenge for accurate diagnosis, especially regarding neurocognitive disorders (NCDs) where side effects like confusion and memory loss can be mistaken for dementia.

Cognitive Impairment

• Certain medications, including those with anticholinergic effects, can induce cognitive impairment similar to dementia.
• Drugs like benzodiazepines and some antidepressants may cause significant sedation, which can be misconstrued as typical aging or an NCD.

Physical Manifestations

• Medication side effects such as dizziness, weakness, or imbalance are common causes of falls, a risk also associated with NCDs.
• Multiple medications can lead to gastrointestinal issues like constipation or diarrhea, symptoms that also align with various chronic conditions.

The Role of Medication Management in Prevention

Effective medication management is vital to mitigate the risks of polypharmacy. This involves a collaborative effort among patients, caregivers, pharmacists, and physicians to ensure all medications, including over-the-counter products, are necessary and appropriate.

Key strategies include:

1. Regular Medication Review: A comprehensive review of all medications should occur at each medical appointment.
2. Deprescribing: This process involves safely reducing or discontinuing medications that are potentially inappropriate, ineffective, or no longer required, under medical guidance.
3. Using a Single Pharmacy: Utilizing one pharmacy helps in monitoring for potential drug interactions.

Comparison: Effects of Polypharmacy vs. NCDs

Differentiating between the effects of polypharmacy and a true NCD requires careful assessment.

Symptom	Associated with Polypharmacy	Associated with NCDs	Key Difference for Diagnosis
Cognitive Decline	Often appears suddenly after a new medication or dose change; may resolve with deprescribing.	Gradual, progressive decline over time; typically not tied to a single medication change.	The timing and reversibility of symptoms are key indicators.
Falls/Dizziness	Can be a direct side effect of medications affecting blood pressure, balance, or alertness.	Often results from neurological damage, gait instability, or other complications of the disease itself.	A careful review of the medication list can reveal contributing drug effects.
Fatigue	Can be caused by sedative effects or drug interactions.	Can be a symptom of the disease, depression, or underlying physiological changes.	Fatigue caused by medication may be relieved by dose adjustments or discontinuation.
Loss of Appetite	May be a direct side effect of a drug, impacting taste or causing nausea.	A common symptom in later stages of many chronic diseases.	Evaluating the timing of symptom onset relative to new drug initiation is important.

The Need for Awareness and Action

Polypharmacy is a significant public health issue that can be overlooked, with symptoms often misinterpreted as part of aging or a new health problem. Increased awareness among healthcare providers, patients, and caregivers is crucial for improving medication safety, especially given the rising prevalence of polypharmacy in an aging population.

Consult the American Geriatrics Society's Beers Criteria for more guidance on potentially inappropriate medications for older adults.

Conclusion

While essential for managing complex health conditions, taking multiple medications carries risks, including the potential to mimic NCD symptoms. This phenomenon is termed polypharmacy. With vigilant medication management, clear communication, and a thoughtful approach to prescribing, healthcare teams can minimize these risks and improve outcomes for older adults.

Frequently Asked Questions

What is polypharmacy?

Polypharmacy is the practice of taking multiple medications at the same time. While there's no universal cutoff, it is often defined as taking five or more drugs daily, including prescriptions, over-the-counter medications, and supplements.

How can taking many medications mimic a non-communicable disease (NCD)?

Drug interactions and side effects can cause a range of symptoms, such as cognitive issues (confusion, memory loss), physical problems (falls, dizziness), or mood changes (depression), that can be mistaken for the signs of a chronic illness like dementia or frailty.

What is a 'prescribing cascade'?

A prescribing cascade occurs when a new medication is prescribed to treat a symptom that is actually a side effect of another medication already being taken. This creates a chain reaction of new prescriptions that can escalate the risk of adverse effects.

Are older adults at a higher risk for polypharmacy?

Yes, older adults are at a higher risk. They often have multiple chronic health conditions requiring medication, and their bodies process drugs differently due to age-related changes in organ function, increasing their sensitivity to side effects.

How can I prevent or manage polypharmacy?

Prevention involves proactive medication management, such as having a comprehensive review of all your medications with your doctor or pharmacist. It's also important to use a single pharmacy and openly communicate any side effects you experience.

What should a caregiver do if they suspect polypharmacy?

A caregiver should maintain an updated list of all the individual's medications, including dosage and frequency. They should bring this list to all medical appointments and discuss any new symptoms or concerns with the healthcare team.

What is 'deprescribing' and how does it help with polypharmacy?

Deprescribing is the process of safely and cautiously reducing or stopping medications under the supervision of a healthcare professional. It helps manage polypharmacy by removing unnecessary or inappropriate drugs, which can reduce side effects and potential risks.