Polypharmacy - simultaneous use of more than one medication- has been recognized as a growing and under-appreciated issue in geriatric healthcare. Increased chronic illnesses include hypertension, diabetes, arthritis, heart diseases and deterioration of the mind accompanied with old age. This has led to a large number of older adults getting into a situation where they are taking five to ten medications or more a day.
Already each drug can be reasonable on its own, however, when taken together, a combination usually forms some unintended risks. Polypharmacy contributes to the probability of adverse drug reactions, drug-drug interaction, decreased medication adherence, cognitive impairment, falls, kidney burden, and hospitalization. Most geriatric patients also get prescriptions by various specialists that result in overlaps or redundancy.
To make the matter worse, physiological alterations that occur with age such as decreased renal clearance, altered hepatic metabolism, and alterations in body composition particularly have significant impact on the manner, in which drugs are metabolised. A normal dose used by a younger adult might be a bad overdose to an old patient though these dose modifications are usually ignored.
Lifestyle habits, deprescribing, and periodic reviews of medication in most instances assist in reducing unnecessary drugs intake. Nevertheless, there is a low level of awareness among caregivers, families or even the patients. Safety in prescribing is a shared duty among clinicians, although it must be a combined effort between pharmacists, caregivers and healthcare systems to promote effective safety in prescription.
Polypharmacy is not just a case of medical concern but an increasing public health challenge that should be addressed particularly among the population of the elderly.
Do you believe that regular medication review and deprescribing should be a compulsory procedure among all old-aged patients to decrease the risks of polypharmacy?
MBH/AB