Polypharmacy. A Serious Problem

It can be safely assumed that as long as there is polyillness, there will be polypharmacy. Four out of every five U.S. adults will use prescription or non-prescription medicines or dietary supplements, and approximately one out of three takes five or more different medications. Further complicating the matter:

• 20% of people over the age of 65 who filled prescriptions had one or more filled for an inappropriate drug.
• Between 14.1% and 94% of those discharged from a hospital to another setting have at least one medication discrepancy during that transition.
• 119,000 deaths per year are attributable to medication-related causes, either directly or indirectly as a result of organ failure from medication.
• Over 175,000 people in the United States over the age of 65 will experience an adverse reaction to one of their medications and will then become patients in the emergency department.

Drug discrepancies can cause adverse drug events (ADEs), which may cause an exacerbation of symptoms, an increase in their acuity level, rehospitalization, injury, and even death.

Defining Polypharmacy

Polypharmacy is the simultaneous use of multiple drugs for one or more co-existing medical conditions. It is generally accepted that five or more medications in one medication regimen constitutes polypharmacy. This number is not difficult to imagine; most of those over the age of 65 take six to eight prescription drugs every day. The American Heart Association says heart failure patients alone take around seven medications per day, and about 40% of these patients have at least five other chronic diseases!

It is important to acknowledge that multiple prescriptions can be and in fact are part of appropriate treatment in many cases. The standard of care for an infinite number of medical conditions includes multiple drug therapies, however best practice recommendations cite a need for balance in the benefit-risk ratio with assigning each and every individual prescription.

How Does It Happen?

Serious consequences from polypharmacy can occur when there is:

• The absence of a clear and reconciled medication list
• A lack of communication between or among different healthcare settings or practitioners
• Unnecessary drug use
• Duplicate drug therapies for the same condition

Vitamins, Supplements, and Over-the Counter Drugs

Many people use drugs without a second thought, like over-the-counter vitamins, herbal products, energy drinks, acetaminophen, aspirin, and ibuprofen. What is not widely known by the general public, however, is the role these drugs may play in the development of adverse drug reactions and events.  Rational thought leads one to conclude the more medications one takes, the higher the risk for an adverse drug interaction.

Consequences

Polypharmacy is associated with increased healthcare cost, increased ADEs, non-adherence to prescribed medication regimens, interference with the ability to function normally, and a number of medical syndromes, many specifically in the geriatric population. In addition, polypharmacy has been linked to:

• Frailty
• Falls
• Unplanned hospitalizations
• Injury and disability
• Death

What Can You Do?

Making sense of often complicated, unconnected medication regimens can be quite a challenge for even the most sophisticated, organized individual. Attention to detail and knowing the right questions to ask, when to ask them, and to whom becomes part of your responsibility when you assume care of another person. In a perfect world, delivery of care would run smoothly and predictably. Unfortunately, that is not a realistic expectation for anyone. Living with more than one chronic medical condition is not uncommon, and each condition is most likely treated by a new specialist who prescribes multiple medications.

The dangers of polypharmacy abound, but you have a unique opportunity to provide a clearer path to health through medication reconciliation practices and mindful, deliberate consideration of the potential consequences of polypharmacy.