Guest blog by Corina Vladut
Of all the aspects I associated with old age as a child (and thought of them as the norm) – being retired, having white hair, “owning” a hand full of colored pills that come after each dinner, sitting on the porch and telling stories – one thing is still present in my family life: the colored pills. And it is this aspect that I want to talk about: taking multiple medications.
Scientifically, it is defined as polypharmacy. Although it may seem that polypharmacy is “bad news”, I have learned three things that anyone should know:
1. What is polypharmacy? It is commonly defined as the concurrent use of five or more medications and excessive polypharmacy refers to the use of 10 or more medications.
2. It is not “bad news”. Taking more than five medications is needed to properly manage certain diseases.
3. Yes, there are risks that we have to be aware of. Polypharmacy can be associated with: over- and inappropriate prescribing which can lead to negative drug interactions and adverse reactions; poor medication adherence (especially in the elderly); functional impairment, falls and fractures, hospital admissions and increased mortality. Read a full report here.
Tilda– The Irish Longitudinal Study of Aging- states that around 69% of the people aged over 50 in Ireland report taking medications regularly, and one in five of them report taking five or more meds. As the prevalence of polypharmacy increases with age, the Tilda study researchers highlight:
- The need for assessing the appropriateness of prescribing in the elderly;
- Being aware of the high levels of concomitant use of food supplements with other drugs (especially in women: 44%) – GPs and pharmacists should discuss the use of food supplements with patients as to reduce potential risks from interactions with other medicines;
- Reviewing medicines’ generic prices in Ireland and finding affordable generic medicine for the elderly. “A further recommendation would be to implement simple access systems for physicians to compare medicine prices when prescribing, which is currently not common practice in Ireland”(pp.24- Polypharmacy in adults over 50 in Ireland: Opportunities for cost saving and improved healthcare, 2012).
Another report – Polypharmacy Guidance, 2012- outlines the factors that should be taken into consideration when identifying patients who might benefit from a targeted medication review. These include: age, counts of numbers of repeat drugs, care home residence or being housebound, functional status, or a combination of these. The guide, developed mainly for clinicians, also highlights the need to be aware of poorly tolerated drugs in frail adults, but also offers good information related to management of dementia (see best practice guide from Alzheimer’s Society).
It seems adequate to conclude with the statement: Treat the person not the disease. Let us try to evaluate the burden of treatment while keeping in mind strategies to improve quality of life; consult with the patient as to balance treatment decisions with risks and benefits for him or her. Let’s try to improve healthcare together: patient, caregiver, health professional!
Read more about polypharmacy here.
Want to know more about Tilda? Watch an audio material about the study here.