How to Manage Polypharmacy in the Elderly

Polypharmacy is a significant issue for the elderly population, affecting as many as four in ten members of this age group.

What is Polypharmacy?

Polypharmacy is the simultaneous use of multiple medications (typically 5+), usually to treat a single issue. It is especially common in areas like pain management, where several different kinds of medication, including antidepressants, muscle relaxants, opioids, and antiepileptics are often used to create an effect greater than their parts.

The polypharmacy definition does not include the sequential use of different medications at different stages of treatment. Sequential use is a normal form of medication management and not a cause for concern.

There are times in which polypharmacy is the appropriate treatment, but doctors try to avoid it because of the consequences associated with it (see below).

Types of Polypharmacy

There are two types of polypharmacy – therapeutic and contratherapeutic polypharmacy.

Therapeutic Polypharmacy occurs as a result of direction and monitoring by one or more clinicians. It is almost always used for a specific therapeutic goal, and both the drugs and their relative amounts are usually set beforehand to ensure there are as few complications as possible.

Contratherapeutic Polypharmacy usually occurs when an individual is not being monitored properly. This can happen because a patient is taking medication without a doctor’s direction, fails to disclose all of the medications they are taking, or continues to take a drug past the time they should have stopped. Some cases of contratherapeutic polypharmacy are deliberate, but others occur entirely on accident.

What Causes Polypharmacy?

There are many different causes of polypharmacy. The most direct cause is that the polypharmacy is intentional – and when it is the goal, it’s usually less of a problem than the issue it’s trying to solve.

Other potential causes of polypharmacy include:

  • Taking The Wrong Pills: Patients may have old medication lying around the house and begin taking them on accident. This can lead to accidental polypharmacy when their doctor believes they’re taking a different drug and accounts for that instead.
  • Deliberate Consumption: Some people take medicine they don’t need. This is particularly common with addictive substances like opioids, where patients may be hesitant to reveal their use of a drug.
  • Too Many Medical Issues: Patients who are suffering from multiple problems may be prescribed medication for each of them, which can lead to unintended drug interactions.
  • Taking Pills At Home: Polypharmacy isn’t limited to pills prescribed by a doctor. Over-the-counter medications that people take at home, like aspirin, can contribute to polypharmacy. So taking this sort of drug when you’re on something else can trigger the problems described below.
  • Managing Side Effects: At times, drugs are given to help manage the side effects of other medications. If too many side effects need management, polypharmacy can set in. Since most side effects don’t affect everyone who takes a given pill, it can be difficult for doctors to know ahead of time whether or not a specific medication will trigger issues that require polypharmacy to manage.
  • Lingering Medication: Some medication is processed quickly, while other drugs can stay in the body for an extended period. Lingering medicines can cause polypharmacy even if you’re no longer taking the drug, which is why you should tell your doctor about any medications you stopped taking in the last three months.

While taking too many pills usually doesn’t cause much damage in the short-term (1-3 days), long-term medicine errors polypharmacy can be dangerous.

Well-known interactions are listed on a given drug’s instructions, usually after some variation of “do not take this drug if you are taking any of the following.” It is vital that you read this section of your medication’s instructions before taking it, even if your doctor wrote you a prescription. Pharmacies sometimes change the prescription if they don’t have a given drug on hand, and they may not know what other drugs you’re taking.

Consequences of Polypharmacy

There are several significant consequences of polypharmacy.

Financial Costs

Taking too many drugs can be incredibly draining on one’s wallet, especially for seniors living on limited incomes. This usually isn’t a problem if the medicines involved are cheap, over-the-counter products, but drugs that run $100 or more per-bottle can add up quickly.

Physical Costs

One of the most significant concerns of polypharmacy is its adverse effects on health. Each new drug can bring new side-effects, increase the risk of unwanted medicine interactions, and take a toll on a given senior’s body.

Polypharmacy is associated with an increased risk of falls, and some of those falls will inevitably be fatal. This consequence, in particular, is why doctors try to avoid polypharmacy whenever they can.

Emotional Costs

Aside from the physical and financial burden, taking too many pills can be taxing on someone’s emotional state. Many pills are consumed more than once a day, and people suffering from polypharmacy may feel like their entire life revolves around taking pills.

Ways to Reduce Polypharmacy

There are several different ways to reduce polypharmacy.

The first – and most important – step is to determine which medications are necessary at any given time. For example, someone suffering from both the flu and a broken bone may want decongestants, antiviral drugs, and painkillers. However, while decongestants may make life more pleasant, they may not be worth the medical risk of mixing them with painkillers.

The next step is determining how much of any given medication is necessary. Some drugs can have their dosage reduced without adverse effects, and lower doses are less of a problem for polypharmacy.

Finally, live a healthy lifestyle to reduce the number of conditions you suffer from. It’s much easier to avoid polypharmacy when you don’t need drugs in the first place.

Preventing Polypharmacy

One of the best ways of preventing polypharmacy is using medication reconciliation and seeing how many drugs are necessary for treatment. Some patients may be able to take one drug for multiple issues, while others look to avoid medication errors by searching for non-pharmaceutical therapies.

Otherwise, it’s best to keep your primary doctor informed of all medications you’re taking. They can help you determine whether or not you’re experiencing polypharmacy – and if you are, they can tell you what to do about it.

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