Polypharmacy is defined simply as the use of multiple medications by a patient. The precise minimum number of medications used to define “polypharmacy” is variable, but generally ranges from 5 to 10.
The issue of polypharmacy is of particular concern in older people who, compared with younger individuals, tend to have more disease conditions for which therapies are prescribed. It has been estimated that 20 percent of Medicare beneficiaries have five or more chronic conditions and 50 percent receive five or more medications.
The use of greater numbers of drug therapies has been independently associated with an increased risk for an adverse drug event (ADE), irrespective of age, and increased risk of hospital admission.
There are multiple reasons why older adults are especially impacted by polypharmacy:
●Older individuals are at greater risk for ADEs due to metabolic changes and decreased drug clearance associated with aging; this risk is compounded by increasing numbers of drugs used.
●Polypharmacy increases the potential for drug-drug interactions and for prescription of potentially inappropriate medications.
●Polypharmacy was an independent risk factor for hip fractures in older adults in one case-control study, although the number of drugs may have been an indicator of higher likelihood of exposure to specific types of drugs associated with falls (eg, central nervous system [CNS]-active drugs).
●Polypharmacy increases the possibility of “prescribing cascades”. A prescribing cascade develops when an ADE is misinterpreted as a new medical condition and additional drug therapy is then prescribed to treat this medical condition.
●Use of multiple medications can lead to problems with medication adherence, compounded by visual or cognitive compromise in many older adults.
A balance is required between over- and under-prescribing. Multiple medications are often required to manage clinically complex older adults. Clinicians are often challenged with the need to match the complex needs of their older patients with those of disease-specific clinical practice guidelines.
Pharmacogenetics is a tool used in long term care communities across the country to help manage polypharmacy. Pharmacogenetics is a simple swab of the cheek that allows providers to look at how medications align with each persons unique DNA. The results help guide providers in proper prescribing eliminating unnecessary medications and guiding them when dosing changes are recommended based on metabolization.
For more information on pharmacogenetics, contact: PGx Medical at 405-509-5112 or firstname.lastname@example.org.