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A Delicate Medication Balance – Keystone Elder Law – Mechanicsburg, PA

Polypharmacy is a term that is used to describe a situation in which an individual is taking multiple medications. The specific number of medications which constitutes polypharmacy has not been established, with some health care professionals and researchers beginning to use the term when four or five medications are prescribed.  Another definition which is sometimes considered is the use of medications which duplicate treatment of a specific condition, are not effective, or are no longer appropriate for the individual’s present state of health.

Older adults are more likely to experience polypharmacy than younger adults since their risk of having multiple chronic medical conditions is higher. In addition, as medical knowledge and the development of new drug treatments increases, sometimes multiple medications may be indicated to treat even a single disease process. In surveys reported by the Centers for Disease Control, data from 2009-2012 illustrated that, of civilians living in the community, 64.8% of those over age 65 took three or more prescription medications within the 30 days prior to the survey, while 39.1% took five or more. The most frequently prescribed medications were those to treat high cholesterol and high blood pressure/heart disease.

Individual behaviors also contribute to polypharmacy. People who see more than one physician are at risk if they do not take ALL of their medications with them to office visits, in order to ensure that each physician has a complete and correct list of prescribed medications. Don’t assume that physicians are automatically going to share patient information with each other.  Patients are also responsible to alert their physicians if they have chosen to use medications differently from how they were ordered. If a medication is prescribed as “take one tablet twice a day;” choosing to take two pills once daily “for convenience” will have a different effect on one’s body than the physician intended.  Individuals who utilize over-the-counter products (both medications and supplements) should alert all of their physicians to the use of these products, since many substances can influence the actions of others.   Having medications filled at more than one pharmacy reduces the effectiveness of pharmacists in monitoring medication regimens for potential complications and maximum effectiveness.  If an individual is concerned about the number of medications that have been prescribed, he/she can be their own best advocate by addressing these factors.  Take advantage of the knowledge of each of your health care providers by ensuring that appropriate communication is present, and think them as your “team.” Without coordination by you as the coach, your team members will be unable to work together to maximize your health, and you will be the one “at risk.”

Polypharmacy may present numerous issues for older adults. Depending on the types of medications involved, a higher number of medications may mean a more complicated regimen that can be difficult or undesirable for an individual to understand and correctly follow.  Higher out-of-pocket costs are likely with more medications, which may lead some seniors with limited incomes to intentionally not take their medications as prescribed, such as cutting them in half to make them last longer or not refilling prescriptions right away. These actions will reduce the effectiveness of the medication. More medications may also mean a greater chance of experiencing side effects or undesirable interactions between the medications, resulting in noncompliance with the prescribed regimen or a change in desired quality of life.  The presence of any of these issues may lead to a decline in functional status or one or more emergency room visits/hospitalizations.  Careful management is required when multiple medications are prescribed, in order to help prevent these complications.

In recent years, studies have been conducted which have highlighted the potential negative effects of polypharmacy on older adults, such as an increased risk of falls, malnutrition, urinary incontinence, adverse drug reactions, and cognitive impairment. Attempts to avoid polypharmacy in older adults have been suggested as the cause of another issue related to medications, that of under-prescribing.  When polypharmacy is viewed simply as the number of medications prescribed, a desire to reduce the number of medicines or reluctance to add new medicines to an individual’s regimen may result in less than optimal treatment of their disease processes.  Thus, in some cases, polypharmacy may be appropriate if an individual’s complete clinical condition is considered, and there is evidence that the medications being prescribed are the most effective form of treatment.

The use of medications to manage disease is a process that involves many complex variables which continue to change over the course of one’s lifetime. An individual’s beliefs and values about medication use; as well as cognitive status, physical functioning, and financial resources will all affect one’s ability and willingness to comply with a medication regimen.  The individual’s age and the mix of diseases and drugs which are involved will affect the body’s ability to process medications.  Finding the right balance of polypharmacy is a task which will probably require trial and error, and the benefits and drawbacks of polypharmacy will vary by individual. Ideally, routine medication reviews should be conducted between individuals and their health care providers, which take into account all of the factors which affect medication use, not just the number of medications which have been prescribed.

Karen Kaslow, RN, BSN