Feb 24, 2016

“Polypharmacy” In The Elderly Highlights Need For Closer Medication Monitoring

Research into elderly people taking multiple medications reveals that many are at increased risk of frailty and even death.

The Australian research project, led by researchers at Melbourne’s Monash University highlights the imperative for patients to have their medical regimes closely monitored.

It’s no surprise that medications are essential for many elderly Australians. Paradoxically, though, as we age and our bodies change, the potential for drugs to conflict or even cancel each other out increases.

Taking five or more medications within 24 hours is known as “polypharmacy”, an activity that is common in the elderly.

In fact, 50% of Australians over the age of 65 are regularly taking at least five different types of medication. With individuals over the age of 75, the numbers even more medications are common.


Video: What is Polypharmacy? How can you reduce your risk? By Jim Gaspard.

“For each additional medicine there was a 22% increase [in the] risk of transitioning from a state of robust health to dying over the study period”, said Associate Professor Simon Bell, from Monash’s Centre for Medicine Use and Safety (and co-author of the research).

The study also found that men were more likely to become frail through polypharmacy. According to the research, polypharmacy has increased since the National Health Survey in 1995, along with the proportion of individuals taking antidepressants and lipid-lowering agents.

In addition, those using sedatives or anticholinergic medicines were much more likely to become pre-frail (showing some signs of age related frailty) or to develop frailty over the study period.

In the nine year study, which followed approximately 1700 community dwelling men aged 70 years and older, frailty was defined as a condition of characteristics by a “limited ability to respond to stressors resulting from cumulative decline across multiple systems”.

According to the researchers, frailty can lead to a spiral of decline, and the more vulnerable the patient, the more exposed they are to increased health problems and worsening disability.

Problematic issues with polypharmacy in the elderly are not unique to Australia.

In 2012, Canadian researchers published the outcomes of research on the impact of polypharmacy in Canadian people over 65.

“Even when controlling for age and number of chronic conditions, the number of prescription medications was associated with the rate of emergency department use”, stated the Canadian authors.

The problems surrounding polypharmacy and the elderly are multiple. Prof Leon Flicker, professor of geriatric medicine at the University of WA, noted that the issue becomes more serious as people age as their bodies were less able to clear medication from the system and were more sensitive to medication side-effects.

Combine these problems with an increasing lack of mobility and often tight personal budgets, many elderly become less diligent in their medical check-ups, allowing problems to go unnoticed.

Prof Flicker said managing elderly patients on multiple medications was a complicated issue, especially when an individual has several medical conditions as most drugs were designed for single diseases. He explained that although controlling the situation was the responsibility of GPs, it is difficult work and takes considerable time to cover accurately. However, there is a strong need for GPs to put more focus on reviewing medicines, along with the overall treatment plans for their elderly patients.

The fact that it’s a lot easier for a doctor to start a patient on a new medication that it is to stop one contributes to the problems with polypharmacy, noted one of the study’s authors, Dr Marie Pirotta.

Fortunately, though, the rules for medical reviews have changed, making it now possible for accredited pharmacists to carry out medication reviews, greatly reducing the burden on GPs.

“GPs have not used home medicine reviews much because they never knew who would be doing the review and the quality of those reviews was variable – but that barrier has gone”, said Dr Janette Randall, chair of the board at NPS.

This new review scheme is considered to be an excellent initiative, particularly when local GPs are already overburdened.

The key to successfully managing elderly person’s medication is twofold: Make sure elderly patients stay up-to-date with medication checks and if more than one doctor is involved, it is imperative that everyone concerned is aware of what others are prescribing. The study was published in the Journal of the American Geriatrics Society.

 

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  1. This is clearly well meaning– and poly pharmacy is a problem among frail, elderly patients.

    But the article is not necessarily accurate.

    Especially for high blood pressure treatment, the current protocol is to use smaller doses of several medications, as opposed to large doses of one or two medication– in the US, in fact, it is recommended that patients with BP over 140/90 start their treatment on two medications.

    The patients with multiple medications: 1) have better blood pressure control; 2) have less side effects.

    In contrast, I agree with you about blood sugar management. Patients are safer, and better treated, using one daily dose of a long-acting insulin, rather than several doses of short-acting insulins. As well, I’m leery about the need for oral medicines for patients taking insulin. For most patients, long-acting insulin alone is sufficient.

    If you’re interested, I’d be delighted to trade some emails with you about polypharmacy.

    Yours,
    Mike Bael, RN

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