Polypharmacy Has Consequences with Aging Adults

Polypharmacy refers to the use of many medications, generally five or more. Since polypharmacy is a consequence of having several underlying medical conditions, it is much more common in elderly patients. However, as more people see multiple doctors you start seeing this issue in people in their 40s and 50s.

The US General Accounting Office reports significant morbidity and mortality associated with inappropriate polypharmacy. Patients 65-years-old and older are the largest consumers of prescription and nonprescription medications in the US, and the use of prescription and nonprescription medications among this group has more than doubled since 1990 and continues to rise, according to the Centers for Disease Control and Prevention (CDC). Elderly Americans consume one-third of all the prescription medications prescribed each year, yet they comprise less than 13% of the population.

Because individuals are living longer and accruing chronic diseases, practitioners have a new responsibility to prescribe appropriately the many medications available to manage concurrent disease states. The problem comes down the road as other medical providers do not know or have unclear reasons for initial prescription. There is a tendency for doctors to let

the patient continue medications they are taking, especially if the indications are unclear or are unknown.

The plethora of pharmaceutical options must be balanced with the potential risk of multiple medication use. These risks include, but are not limited to, adverse effects, drug/drug interactions, drug/disease interactions and inappropriate dosing regimens. In addition, many doctors are hesitating to prescribe a new essential mediation to a patient already on five or medications.

If you or an older family member is taking prescription and over-the-counter drugs, there are generally side effects from some of them. Often, negative drug interactions occur.

You also may have prescriptions from different physicians who are unaware of other medications prescribed by other doctors. A primary care physician may just allow you to continue to take a drug prescribed by a specialist without question. Also, many times a person may not understand the reason for taking the drug in the first place.

In addition, some people may fill prescriptions at different pharmacies or online. A pharmacist won’t be able to warn a consumer of dangerous drug interactions unless they know all the medications a person is taking.

Serious health issues can be caused just because of the numerous drugs a person is taking. If a person is living in an assisted living facility, memory care facility or nursing home the impact of polypharmacy can be greater depending on the quality of the facility and the involvement of family members in their care.

If you are under age 65 and on five or more medications already be sure you understand the reason for each medication and ask for doctor if you need to continue taking each medication. Understand that with aging the effectiveness of some drugs start to wane. New medications may interact with older ones. 

Everyone at all ages should keep a list of each medication and the name of the doctor who prescribed it with you. Ideally you should get all your medications filled at one location, so a pharmacist is aware of each medication and can warn you of any interaction issues.  

AgingCare.com (https://www.agingcare.com/articles/polypharmacy-dangerous-drug-interactions-119947.htm) lists the following symptoms of polypharmacy:

• Tiredness, sleepiness or decreased alertness
• Constipation, diarrhea or incontinence
• Loss of appetite
• Confusion, either continuous or episodic
• Falls
• Depression or general lack of interest
• Weakness
• Tremors
• Hallucinations, such as seeing or hearing things
• Anxiety or excitability
• Dizziness
• Decreased sexual behavior
• Skin rashes

Be sure each doctor you see is aware of all medications that are being taken, including over-the-counter, and the reason the drug is being used. On an annual basis, be sure to ask if each medication is still necessary and effective for treatment of the condition it is being prescribed for. Keep this list with you at all times, just in case.

If you have an older family member in a Long-Term Care facility make sure someone is reviewing the medications. Be sure to ask the duty nurse if any symptom your loved one may be experiencing could be a side-effect from a medication, a drug interaction or from polypharmacy itself. 

If you are younger be sure to apply for Long-Term Care Insurance prior to being treated for multiple health conditions. Most insurance companies will not be favorable to applicants who take too many medications. While the conditions themselves are a major concern, a person with five or medications will be looked at much more closely. Generally, experts suggest purchasing a policy as part of retirement planning prior to retirement (40s or 50s) as the chance of getting approved for coverage is much higher and some people may qualify for preferred health discounts.

Aging requires advance planning and paying attention to details. Polypharmacy can become a major issue with aging.