Polypharmacy among the elderly

There is no firm definition of polypharmacy, but the American Family Physician website mentions the regular use of five or more drugs as one definition. These can be prescription or over-the-counter drugs. People see multiple doctors so end up with many prescriptions, sometimes working at cross purposes to each other. For this reason, geriatric specialists recommend that the primary care physician occasionally assess a patient's overall drug regimen. The American Geriatrics Society developed the Beers Criteria as a tool for healthcare providers to check for possible dangerous combinations of medicines.

There are actually two phenomena that people use the term polypharmacy to describe:

  1. Using more than one drug for a given illness. This is very common in managing hypertension and treating cancer.
  2. When a patient uses multiple drugs, for one or more conditions. This is common among older people.

Polypharmacy happens to people of all ages, but it is particularly prevalent among the elderly. More than 90 percent of old people use more than one medicine.

Related to polypharmacy is multimorbidity, which means a person has more than one chronic health condition. More diseases usually means more medicines. In addition to the risk of drug-drug interactions, polypharmacy in a person with multiple conditions increases the chances of a drug making another disease (not the one it is intended to treat) worse. Pharmacodynamics - how a medicine affects a person given different biochemistries and genetic profiles - is difficult enough for experts to work out when it is just one medicine and one condition. Factoring in different medicines and different conditions makes it all the more complex.

The bodies of older people are less efficient at processing drugs through the body. Renal and hepatic function can be reduced and it is typically the liver and kidneys that remove drugs. So any medicine is more fraught with risk in the elderly than in younger people.

Compliance is defined as the degree to which a patient correctly follows medical advice. The more preferred term today is adherence. Although the terms are related, compliance suggests that the patient is passively following the physician’s orders, while adherence acknowledges that the patient is part of the decision-making process, making this the preferred term. Another frequently encountered word is persistence, defined as the duration of time over which a patient continues to fill the prescription. This often declines over time, especially among the elderly who are plagued with low incomes, poor memories, and apathy.