What You Need to Know About Polypharmacy

Understanding Polypharmacy

Polypharmacy, a growing concern in healthcare, refers to the use of multiple drugs or more medications than are medically necessary. It has a significant impact on older adults, who often face multiple health conditions and take multiple medications to manage their health.

Definition and Scope

Polypharmacy is characterized by the use of excessive medications, either in terms of quantity or appropriateness. The exact definition may vary, but it generally refers to the use of more medications than are necessary for a specific individual's condition. This can include prescribed medications, over-the-counter drugs, and herbal supplements.

The scope of polypharmacy extends beyond the number of medications used. It also considers the appropriateness of drug therapy, potential drug interactions, and the patient's ability to manage and adhere to their medication regimen. Polypharmacy often occurs unintentionally, as a result of multiple healthcare providers prescribing medications without adequate coordination or awareness of the complete medication list.

Impact on Older Adults

Polypharmacy is particularly prevalent among older adults, who may be managing multiple chronic conditions simultaneously. According to studies, nearly 50% of older adults take one or more medications that are not medically necessary. The use of excessive medications can lead to various negative consequences and adverse health outcomes.

The impact of polypharmacy on older adults includes increased healthcare costs, adverse drug events, drug interactions, medication non-adherence, reduced functional capacity, and multiple geriatric syndromes. Polypharmacy significantly affects the elderly age group, leading to poor compliance, medication errors, and avoidable adverse drug events (ADE) that can result in complications. It is estimated that polypharmacy costs Centers for Medicare and Medicaid Services (CMS) around 50 billion dollars annually.

To address the challenges associated with polypharmacy in older adults, it is crucial to raise awareness among healthcare providers and implement strategies to optimize medication use. This includes proper medication review, deprescribing when appropriate, and promoting inter-professional collaboration to ensure comprehensive patient care. By understanding the definition and scope of polypharmacy and its impact on older adults, healthcare professionals can take proactive steps to mitigate the risks and improve patient outcomes.

Prevalence and Consequences

Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern, particularly for older adults. Understanding the prevalence and consequences of polypharmacy is essential for addressing this issue effectively.

Statistics and Findings

The prevalence of polypharmacy among older adults is significant. Nearly 50% of older adults take one or more medications that are not medically necessary. In a study conducted in the USA, it was found that 37.1% of men and 36% of women aged 75-85 years took at least five prescription medications.

Negative Health Outcomes

Polypharmacy has been associated with various negative health outcomes. These include increased healthcare costs, adverse drug events, drug interactions, medication non-adherence, reduced functional capacity, and multiple geriatric syndromes. The impact of polypharmacy is significant, particularly for the elderly population, leading to poor compliance, drug interactions, medication errors, and avoidable adverse drug events. In fact, polypharmacy costs the Centers for Medicare and Medicaid Services (CMS) approximately 50 billion dollars annually.

Patients with polypharmacy also experience a negative impact on their health-related quality of life (HRQOL). Studies have shown that patients with polypharmacy report worse HRQOL in terms of the EQ-5D-5L index values, EuroQol visual analogue scale (EQ-VAS) scores, SF-12 physical component scores (PCS), SF-12 mental component scores (MCS), and HADS anxiety and depression subscales compared to patients without polypharmacy. Polypharmacy is significantly associated with lower HRQOL in terms of the EQ-5D-5L index, EQ-VAS, and SF-12 PCS, particularly affecting the physical domain of HRQOL among patients with chronic diseases.

In summary, the prevalence of polypharmacy among older adults is a significant concern, with a substantial number of individuals taking multiple medications that may not be medically necessary. This trend has been associated with a range of negative health outcomes, including increased healthcare costs and adverse drug events. Additionally, polypharmacy has been found to have a negative impact on health-related quality of life, particularly in terms of physical well-being. Addressing polypharmacy and its consequences is vital for improving the overall health outcomes and quality of life for individuals affected by this issue.

Factors Contributing to Polypharmacy

Polypharmacy, the use of multiple medications, is a growing concern, particularly among older adults. Several factors contribute to the prevalence of polypharmacy, including the rising elderly population and comorbid conditions.

Rising Elderly Population

The aging population plays a significant role in the increase of polypharmacy cases. As individuals grow older, they are more likely to develop multiple chronic health conditions that require ongoing medical management. Age-related physiological and pathological changes make older adults more susceptible to multi-morbidity, which is the coexistence of two or more chronic health conditions [4].

With the aging process, the risk of being prescribed multiple medications also increases. The cutoff point of five drugs is often used to define polypharmacy, as exceeding this threshold is associated with adverse outcomes such as falls, frailty, disability, and mortality in older adults.

Comorbid Conditions

Comorbidity refers to the presence of multiple health conditions in an individual. Older adults, in particular, are more likely to have comorbid conditions, which can necessitate the use of multiple medications for their management. Polypharmacy is commonly observed in older adults with multiple chronic conditions, as well as in younger adults with complex health conditions, chronic pain, developmental disabilities, or mental health conditions.

The use of multiple medications in patients with mental health conditions is prevalent, often resulting in adverse effects. This highlights the importance of appropriate medication management and the need to balance the benefits and risks associated with polypharmacy in these individuals.

Understanding the factors contributing to polypharmacy is essential in addressing this issue effectively. By recognizing the impact of the rising elderly population and comorbid conditions, healthcare providers can implement strategies to optimize medication regimens and improve patient outcomes.

Addressing Polypharmacy

Polypharmacy, the use of multiple medications by an individual, can pose significant risks and challenges to patient health. To mitigate these risks, various approaches have been developed to address polypharmacy. Two important strategies are the deprescribing approach and inter-professional interventions.

Deprescribing Approach

Deprescribing is a systematic process aimed at identifying and discontinuing medications when the potential harm outweighs the benefit or when the benefit is unclear. The goal of deprescribing is to reduce the adverse consequences of polypharmacy and optimize medication regimens for individual patients. This approach involves a collaborative effort between healthcare providers and patients to make informed decisions about medication use.

Pharmacists play a crucial role in deprescribing by providing education about drug safety to physicians and patients. Through their expertise, pharmacists can identify medications that may no longer be necessary or may be causing harm due to drug interactions or side effects. Pharmacist intervention has shown to decrease polypharmacy and improve medication management in older adults.

When considering deprescribing, it is essential for physicians to view it as a therapeutic intervention, similar to initiating appropriate therapy. The process should involve a careful review of the patient's medications, taking into account their goals and preferences. Shared decision-making between the healthcare provider and patient, along with discussions about the potential benefits and risks of deprescribing, is crucial in ensuring the best outcomes for the patient.

Inter-Professional Interventions

Inter-professional interventions have been proven effective in improving the overall quality of prescribing for high-risk older patients with polypharmacy. These interventions involve a collaborative approach among healthcare professionals, such as physicians, pharmacists, and nurses, to optimize medication regimens and ensure patient safety.

Through inter-professional interventions, healthcare providers work together to review and assess the patient's medication regimen, identify potential drug interactions or duplications, and make appropriate adjustments. This collaborative effort enhances communication and coordination among the healthcare team, leading to more comprehensive and patient-centered care.

By leveraging the expertise of different healthcare professionals, inter-professional interventions can address the complex medication needs of patients with polypharmacy. The involvement of multiple perspectives and specialties helps to ensure that the medication regimens are tailored to the individual patient's needs and minimize the risks associated with polypharmacy.

Addressing polypharmacy requires a multifaceted approach, and the deprescribing approach and inter-professional interventions are essential components of managing polypharmacy effectively. By employing these strategies, healthcare providers can help optimize medication use, reduce the risk of adverse effects, and improve outcomes for patients with polypharmacy.

Health-Related Quality of Life

Polypharmacy, the use of multiple medications by an individual, can have a significant impact on health-related quality of life (HRQOL). It affects various aspects of well-being, including physical and mental health.

Effects on HRQOL

Patients with polypharmacy often report worse HRQOL compared to those without polypharmacy, as indicated by various measures. According to a study published by the CDC, patients with polypharmacy had lower scores in terms of the following HRQOL measures:

• EQ-5D-5L index values: This index measures overall health status and functioning. Lower index values indicate poorer HRQOL.
• EuroQol visual analogue scale (EQ-VAS) scores: These scores reflect an individual's self-rated health on a scale from 0 to 100. Lower scores indicate lower HRQOL.
• SF-12 physical component scores (PCS): This component of the Short Form Health Survey assesses physical well-being. Lower scores indicate poorer physical HRQOL.
• SF-12 mental component scores (MCS): This component of the Short Form Health Survey assesses mental well-being. There was no significant association between polypharmacy and mental HRQOL in the aforementioned study.

These findings suggest that polypharmacy can have a negative impact on various dimensions of HRQOL, particularly in terms of physical health. However, it's important to note that the impact on mental HRQOL may vary among individuals.

Impact on Physical and Mental Well-being

Polypharmacy can negatively affect both the physical and mental well-being of individuals. The burden of managing multiple medications, understanding their purposes, and recognizing potential side effects can create challenges and impact overall HRQOL.

Physically, polypharmacy has been associated with adverse outcomes such as increased mortality, falls, adverse drug reactions, longer hospital stays, and readmission to the hospital shortly after discharge. These factors can contribute to a decreased sense of well-being and overall physical functioning.

Mentally, while the aforementioned study did not find a significant association between polypharmacy and mental HRQOL, it is important to recognize that managing multiple medications can add complexity and stress to an individual's daily life. The cognitive burden of adhering to multiple medication regimens may impact mental well-being, leading to potential challenges in overall HRQOL.

Understanding the potential impact of polypharmacy on both physical and mental well-being is crucial for healthcare providers and individuals managing multiple medications. By recognizing these effects, interventions can be tailored to address the specific needs of patients with polypharmacy, aiming to optimize HRQOL and overall health outcomes.

Tools and Strategies

When it comes to addressing and managing polypharmacy, there are various tools and strategies available to healthcare professionals. These aim to identify inappropriate medications and guide the deprescribing process, ensuring that medication regimens are optimized for patient safety and well-being.

Identifying Inappropriate Medications

One of the key tools used to identify potentially inappropriate medication use in polypharmacy is the Beers criteria. The Beers criteria provide a list of medications that may be potentially inappropriate for older adults, taking into consideration factors such as the medication's side effects and the individual's health status [5]. Additionally, other tools like the STOPP (screening tool of older people's prescriptions) and START (screening tool to alert to right treatment) criteria, as well as the Medication Appropriateness Index, can be utilized to evaluate medication appropriateness in older adults.

It's important to note that while these tools are valuable in identifying potentially inappropriate medications, no single tool or strategy has been shown to be superior in improving patient-related outcomes and decreasing the risks associated with polypharmacy. Therefore, a comprehensive evaluation of each patient's medication regimen and individual factors is crucial for making informed decisions.

Deprescribing Considerations

Deprescribing is a systematic process that involves identifying and discontinuing medications when the existing or potential harms outweigh the benefits. It is important for healthcare professionals to view deprescribing as a therapeutic intervention, similar to the initiation of clinically appropriate therapy.

During the deprescribing process, it is essential to consider patient/caregiver perspectives on therapy goals and preferences. Shared decision-making plays a crucial role, as healthcare professionals discuss the potential benefits and risks of deprescribing with the patient. This approach ensures that the patient's values and preferences are taken into account, supporting patient-centered care.

Healthcare professionals may also consider factors such as the patient's overall health, the potential for drug-drug interactions, and the patient's ability to manage their medication regimen. Collaborative efforts among healthcare providers, including pharmacists and other specialists, can help optimize the deprescribing process and ensure patient safety and well-being.

By utilizing tools and strategies to identify inappropriate medications and carefully considering the deprescribing process, healthcare professionals can play a vital role in reducing the risks associated with polypharmacy and promoting optimal medication use for patients. It is important to approach each patient's medication regimen on an individual basis, taking into account their unique circumstances and goals.

References

• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3864987/
• ‍https://www.ncbi.nlm.nih.gov/books/NBK574550/
• ‍https://www.cdc.gov/pcd/issues/2022/22_0062.html
• ‍https://www.ncbi.nlm.nih.gov/books/NBK532953/
• ‍https://www.aafp.org/pubs/afp/issues/2019/0701/p32.html
• ‍https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5635569/