6 PRACTICAL STRATEGIES TO REDUCE POLYPHARMACY IN OLDER ADULTS

Polypharmacy in older adults is a serious health concern. As we age, our bodies undergo metabolic changes that can impair drug clearance and increase the likelihood of adverse drug reactions.

Unfortunately, with advanced age comes several age-related health concerns, often leading to an increase in prescribed medications. While these medications may be necessary to manage these health conditions, they can also increase the risk of adverse drug reactions, drug interactions, and other health complications.

In this blog post, we’ll discuss factors contributing to polypharmacy in older adults, its consequences, and actionable steps pharmacists can take to reduce it in this group.

By understanding the underlying causes of polypharmacy and implementing these strategies, you can help improve the quality of life of your patients and reduce their risk of medication-related complications.

What is Polypharmacy?

Polypharmacy refers to using multiple medications by a single patient (usually older adults). It is often measured as taking five or more medications regularly.

It is important to note that the medications involved in polypharmacy are medically prescribed medications needed by the patient to maintain their health conditions. However, the compromised metabolic state of the aged body has become a concern for medical professionals.

Factors that Contribute to Polypharmacy in Older Adults

Different factors contribute to polypharmacy in seniors, including:

• Multiple Chronic Conditions.

  
  

As people age, they often develop multiple chronic conditions like diabetes, heart disease, and rheumatoid arthritis. Each of these conditions usually requires a different treatment regimen, which leads to taking several prescribed medications.

• Multiple Care Providers.

Older adults may likely consult with multiple healthcare providers, such as primary care physicians, specialists, and pharmacists. This can lead to fragmented care and potential medication duplication or interactions.

• Cognitive Decline.

Most older adults often experience some level of cognitive decline like dementia, Alzheimer’s, etc. This cognitive decline leads to constant forgetfulness, and someone who has to manage multiple medications may forget to take pills, take the wrong dosage, or repeat medications unintentionally.

Consequences of Polypharmacy in Older Adults

Here are some dangers of polypharmacy in the elderly population:

• Drug-drug Interactions.

When multiple medications are taken simultaneously, there’s an increased risk of drug interactions. These interactions can lead to decreased efficacy of medications, increased side effects, or even severe health consequences.

• Higher Fall Risk.

Studies have shown that one of the effects of polypharmacy in older adults is an increase in fall risk. 

However, there are claims that the increased fall risk is associated with the type of medications used rather than the number. A study that showed an increase in patients given anticholinergics and sedatives supports this theory.

• Harmful Medication Side Effects.

Each person reacts to drugs differently, and so each prescribed medication might have one or two side effects on the patient. As the number of medications increases, so does the likelihood of experiencing adverse, cumulative side effects.

The side effects from each drug might be mild, but when the drugs are taken simultaneously, these side effects can be aggravated and lead to medical complications.

• Hospital Readmissions.

Polypharmacy increases the risk of drug-drug interactions within the body and aggravated side effects. These can result in acute health problems that will require readmissions and hospitalization.

• Non-adherence to Medications.

Polypharmacy in older adults can often lead to non-adherence because taking multiple medications can be complicated for a young person, not to talk of an older adult who might be experiencing difficulties in focusing and remembering.

Multiple medications can mean different dosages, timing, and routes, which can be difficult for an older person to manage effectively.

• Higher Healthcare Costs.

Polypharmacy is associated with increased healthcare costs due to higher rates of readmissions, hospitalizations, emergency room visits, and medication expenses. 

This is often a result of the medication-related complications that arise, like adverse drug reactions, complicated side effects, and drug-drug interactions.

• Lower Quality of Life.

Polypharmacy can negatively impact an older adult’s quality of life. Side effects from medications can cause discomfort, fatigue, and other symptoms that interfere with daily activities and overall well-being. 

Strategies to Reduce Polypharmacy in Older Adults

The following practical strategies can be used to reduce the risk of polypharmacy in older adults:

• Proper Medication Review.

One of the most effective strategies for reducing polypharmacy in older adults is a comprehensive medication review. 

When a patient’s profile reflects that they have comorbidities (two or more chronic conditions), pharmacists should pay closer attention to all the patient’s prescribed medications and reconcile their medication history to identify potential drug interactions, predict adverse drug reactions, and take measures to prevent them.

Pharmacists can also ensure the patient uses only one drug that performs the same purpose.

• Medication Reconciliation using EHRs.

Proper medication reconciliation can be guaranteed (to a large extent) when electronic health records are utilized for patients.

This guarantees that the pharmacists and other relevant healthcare professionals are aware of changes in the patient’s medications, and even if the patient sees different professionals, all the necessary information needed for diagnosing and prescribing the proper medications is within reach.

In other words, leveraging EHRs ensures the pharmacist has an accurate and up-to-date list of patients’ medications. 

• Deprescribing Medications.

This method is another effective approach to reducing polypharmacy in older adults.

Deprescribing medications starts with a proper medication review, during which the pharmacist identifies medications that can be discontinued (stopped) because they are no longer effective or needed by the patient.

For effective deprescribing, pharmacists must collaborate with other healthcare professionals to identify medications contributing to adverse effects or causing unnecessary harm to the patient.

When this is done, they also need to develop a safe and effective deprescribing plan that considers the patient’s specific needs and preferences.

For example, a deprescribing plan can range from gradually reducing dosages to discontinuing the medications instantly.

• Medication Regimen Simplification.

Pharmacists can help simplify medication regimens for older patients by combining or compounding medications, adjusting dosages, or suggesting alternative therapies. This can help improve medication adherence and reduce the risk of medication errors, especially with older adults.

• Utilizing Geriatric Pharmacy Services.

Geriatric pharmacy services offer specialized care for older adults. 

Pharmacists who specialize in geriatrics have a deeper understanding of the unique challenges faced by the elderly population. 

They can conduct comprehensive medication reviews for older adults, screen them for adverse drug reactions, and help simplify their medication regimens.

Geriatric pharmacists are specially trained; by leveraging their services, patients can optimize medication therapy.

• Addressing Social Factors.

Social factors, such as poverty, limited access to healthcare, and lack of social support, can contribute to polypharmacy in older adults. 

Pharmacists can play a role in addressing these factors by collaborating with community organizations and healthcare providers. 

For example, pharmacists can work with community health centers to provide medication counseling and education to underserved populations. 

Pharmacists can also collaborate with social workers to offer social support services, such as home healthcare or meal delivery, which is critical for older adults with limited mobility due to age or health conditions.

Conclusion

As a pharmacist, it is crucial to be vigilant for any signs of adverse drug reactions, such as unusual symptoms or changes in behavior, especially when dealing with older patients.

A proactive approach to medication management is vital to reducing the risk of polypharmacy in older adults. 

Whenever you are unsure of the effects of certain medications for your patient, you can refer them to a geriatric pharmacist for specialized counseling and care.

Remember, the goal should be patient safety.

READ MORE: THE REVOLUTIONIZING ROLE OF COMMUNITY PHARMACISTS IN PUBLIC HEALTH