Polypharmacy: Risks and Prevention

Introduction

Polypharmacy is a common phenomenon in older adults who use multiple medications.  This paper will aim to explore the issue of polypharmacy especially in older adults. The paper will discuss the nature of polypharmacy, its significance, its significance and occurrence. The paper will also dwell on social factors, expenses and the risk of adverse drug interactions in older people. The paper will finally examine past and present attempts to prevent the adverse effects of polypharmacy.

Definition of polypharmacy

Polypharmacy is a term which is used to mean ‘many drugs’ and it refers to problems that can occur if a patient takes more medicines than actually needed. The problem especially affects older adults who constitute 13 percent of the population but who account for about 30 percent of all the prescribed drugs. Most of these older adults take one or more of the prescribed medicine plus other OTC drugs without informing their clinicians. Although some have no problems, others suffer because of the combination of the drugs they are taking. Therefore polypharmacy can be referred to as the prescription of many drugs either appropriately or inappropriately (Kaufman, G., 2011).

Who is at risk of polypharmacy?

Polypharmacy especially affects people aged 65 years and older where the chances are that these older people take one or more prescription drugs and other over the counter drugs to keep health. Polypharmacy does not have to happen but if a person feels that he has too many drugs to take at a single given time, s/he should consult the doctor.

Adverse drug interactions

According to Kaufman, polypharmacy has the effect of increasing the likelihood of experiencing drug to drug interactions. Polypharmacy is affected by the number of drugs taken, increase in age and the number of prescribers involved in the patient’s care.

Adverse drug reactions especially in older adults are a common cause for admission to hospital. Adverse reactions do cause a number of problems in older people and some of these problems include depression, dizziness, constipation, immobility, insomnia and confusion. These effects are just a beginning of events that lead to disability and finally death in older adults. Some of these effects do result in falls which may lead to fractures. Polypharmacy is usually overlooked because its symptoms may be confused with normal symptoms of aging or another disease, and this may result to further description of drugs. (Kaufman, G., 2011).

Medication therapy to improving polypharmacy

For many years, efficient nurses have made it a practice to review a patient’s medication at every hospital visit. In managing polypharmacy is for the clinician to have a complete and thorough medical history of the patient. The patient is usually asked to bring in all prescriptions and non-prescription drugs s/he is using every time s/he visits a clinic. Additional probing may also be necessary to fully ascertain the extent of OTC drugs the patient uses because such drugs like multivitamins and herbal medicines may be left out. The health care provider on being provided with the drugs the patient uses should ascertain whether all the drugs are necessary for use (Hutchinson, L.C. and Sleeper, R.C., 2010).

But starting in 2009, with technological advancements, the Joint Commission for Hospital Accreditation in the USA requires that medical reconciliation be one of the processes used to prevent polypharmacy and other forms of suboptimal drug use. Reconciliation should be done whenever a patient is transferred between hospitals or even when a patient visits a hospital for the first time while checking his/her medical history.  Medical reconciliation also helps transition a patient’s medication between various formulary restrictions. It is especially important that clinicians consider the necessity of medications as patients near the end of their lives as the usefulness of some medications may be limited due to a shift from curative to palliative uses (Hutchinson, L.C. and Sleeper, R.C., 2010).

The incidence of polypharmacy

A 2004 United States health report shows that prescription drug use is rising among people of all ages and that the incidences increases with age. The report by National Center for Health Statistics, 2004shows that almost half of people over the age of 18 are taking at least one prescription medicine while a sixth are taking three or more. This percent is however higher with adults over 65 years. The reason is attributed to increasing ability to treat and prevent chronic illnesses which results to patients accumulating drugs as they age. Interestingly though is that prescription drug use is on the rise and the number of medication treatment for chronic disease are also increasing. The use of specific psychotic medications in younger patients was also reported to be on the increase.

Expenses involved in treating polypharmacy

Recent data shows that the problem of polypharmacy is becoming a major focus of taxpayers. Information shows that polypharmacy situations cost the US $177 billion in 2001 in medical costs and other associated costs in managing adverse drug events. The data shows that the number of seniors developing from the health condition has more than doubled since 1999 and this translates to increased medical costs in managing the condition. But a managed care organization, the Health Alliance Plan has started a polypharmacy program for its members and it hopes to save $4.5 million in drug costs for a period of three years. Pharmacists have been requested to start working with these patients who are at risk of polypharmacy and thus help in adjusting medication regimens where it is necessary for safety and efficiency reasons. Although such programs like this by HAP have benefitted health plan members and clients too, Medco health solutions gives a warning that millions of the elderly who are not insured are not protected by such ‘safety net’ and the taxman is paying for the costs (Findarticles.com).

Los Angeles County's prevention measures of polypharmacy

The county of Los Angeles has instituted measure to help combat and help in injuries and violence prevention in the county.  The county has a list of leading causes of injury fatalities and hospitalizations. They have documented the risk factors associated with the leading causes and they have listed polypharmacy (the use of multiple medicines at the same time) as one of the causes. Some of the county’s current program focuses on data collection and collaborations with other agencies to improve the safety of the county. A program for senior health in the county is charged with the mission of maximizing the health and quality of life for all older adult and promotes healthy aging among this group. They access and monitor the health status of the 65+ population and ensure that they are access health care.

Conclusion

We have discussed about polypharmacy which is the administration of several drugs usually for multiple medical conditions. The term is also used to refer to prescription of many drugs appropriately or inappropriately. The prescription of multiple drugs is especially common in older adults who have a number of many medical conditions. Problems related to polypharmacy include adverse drug interactions. In prescribing of multiple drugs, it requires sound clinical judgment and in depth knowledge of prescribing drugs for older adults. Patients on multiple drugs should also be frequently monitored to detect any adverse effects of polypharmacy and protect older people’s health.

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