How does polypharmacy affect the elderly?
People over 65 years, who may take daily medications for multiple chronic conditions, are at risk for overmedication and other complications of polypharmacy. Complications can include sedation, increased risk for falls and other side effects.
NICE defines medicines optimisation as a:
“Person-centred approach to safe and effective medicines use, to ensure people obtain the best possible outcomes from their medicines.”
The World Health Organization (WHO) describes polypharmacy as a major global problem and has set a global safety challenge to avoid medicine-related harm. Patients being prescribed a higher number of medications has been associated with an increased risk of harm and is a strong predictor of hospitalisation due to adverse drug events.
Adverse drug reactions (ADRs) cause about 1o% of unplanned hospital admissions, and contribute to 30% – many of these are predictable. 70% of these patients are older on multiple medications. This presents a significant opportunity for intervention.
In addition to potential harm, polypharmacy poses a huge financial pressure on the NHS.. Despite this, only 50% of medications prescribed are taken as intended; costing the UK in 2007 up to £200 million each year in wasted medication
Polypharmacy can be defined as appropriate polypharmacy or problematic polypharmacy:
- Appropriate polypharmacy – Prescribing of multiple medications for an individual with complex conditions; or for multiple conditions in circumstances where medicines use has been optimised
- Problematic polypharmacy – Prescribing of multiple medications inappropriately or where the intended benefit of the medication is not realised. The following examples would contribute to polypharmacy being considered inappropriate:
- Use of a treatment is not evidence-based
- Risk of harm outweighs the benefits of treatment
- Drug interactions lead to unintended side-effects
- Unacceptable pill burden making it difficult to achieve clinically useful medicine adherence.
Appropriate polypharmacy can extend life and improve patient outcomes. However, problematic polypharmacy can increase risk of drug interactions and impair quality of life. Consequently, medication optimisation is essential.
Summary
We have described how does polypharmacy affect the elderly. We hope it has been helpful.
Other resources
Prescribing in the elderly (BNF)
NHS Wales’ advice on reducing polypharmacy (deprescribing) in the frail elderly.
