If you or your loved one hasn’t been feeling right it might be time to visit your physician. Over medication, or Polypharmacy in the elderly is becoming a growing problem for many. So what is Polypharmacy?
Polypharmacy means the use of more drugs than is clinically indicated or warranted. The elderly population is approximately 12% of the population but they receive 32% of the prescriptions. The average use of medications of a person age 65 is 2 to 6 prescription drugs and 1 to 3.4 over the counter medications. The elderly use more drugs because illnesses such as cardiovascular disease, arthritis, gastrointestinal disorders and bladder dysfunctions are more common in older people.
Why the fuss over polypharmacy?
Polypharmacy leads to more adverse drug reactions and decreased adherence to drug regimens. The result for the patient is poor quality of life, high rate of symptomatology and unnecessary drug expenses.
The most consistent risk factor for adverse drug reactions is the total number of drugs being taken. The risk rises exponentially as the number of drugs increases. At two drugs a 2% Adverse Drug Reaction (ADR) occurs at 4 drugs a 4% ADR at 10 drugs a 10% ADR and at 18 Drugs the risk for an adverse reaction increases to a whopping 80%. These reactions occur more in the elderly since they are consuming more medications and their bodies are not processing these medications in the same manner as it use to due to the aging process. This process is also known as pharmacokinetics.
Pharmacokinetics and the aging, what the human body does to the drug, consists of the following four processes. The body will absorb the drugs, distribute the drugs, metabolize the drugs and finally excrete the drugs.
With absorption of the medication, age related gastrointestinal tract and skin changes seem to be of minor clinical significance for medication usage. For the distribution of the drugs important age-related changes such as lean body mass , total body weight and percentage of body fat need to be considered especially when lipophilic drugs, such as sedatives that penetrate the central nervous system that are prescribed. With metabolism liver function tests are unchanged with age but there is still some overall decline in metabolic capacity. This may be caused by decreased liver mass and hepatic blood flow. Finally excretion is decreased due to decreased renal blood flow and lower kidney filtration rates.
The Patient and Physician Contribute to Polypharmacy
The patient does not always share their symptoms, may have multiple providers and may be taking over the counter medications and vitamins that their doctor may not be aware of. The physician may have limited time to see the patient and may have limited knowledge of geriatric pharmacology.
What is recommended on a yearly basis is that primary care physicians should have their elderly patients bring in all medications they have at home that they are taking. This “Annual Brown Bag” should include prescriptions, over the counter medications, and all vitamin and herbal supplements that are being used. Vitamin and Herbal supplements need to be considered because there have been some serious drug interactions with certain prescriptions and the following vitamins: Warfarin, Gingko Biloba and Vitamin E. The “Annual Brown Bag” needs to be documented and sorted through to see what medications can be eliminated. Which medications are vital versus optional, which are a cure versus relief of a symptom. The result needs to be a plan to reduce the total number of pills that are being consumed each day by the patient.
The patient can also take some responsibility to avoid any adverse reactions by using one pharmacy, avoid seeing multiple physicians, do not use medications from others, and report all symptoms so their physician can make the correct diagnosis. They also have to remember that even over the counter medications and vitamins have adverse effects and that all products being used should be shared with their physician.
This article has been written by Always Best Care Senior Services of Central Connecticut, The Leader in Non-Medical In Home Care and Free Independent and Assisted Living Placement” in connection with McGraw-Hill, Essentials of Clinical Geriatrics, 4th Edition. Kane, Ouslander, Abrass, Eds. Please visit our website to learn more about our company. www.abccentralct.com
