Older adults are the largest consumers of medication in the United States (US), largely due to an age-associated increase in chronic conditions. 1 Because of this, multiple medication use (i.e., polypharmacy) is a common consequence of providing health care to older adults. 2 Polypharmacy is of particular concern to older adults because they may have unique barriers and challenges to managing multi-drug regimens, including cognitive impairment, functional limitations, financial restraints, use of multiple health care providers, or transportation limitations, to name a few. 2, 3 In addition, one of the most significant potential consequences of polypharmacy could be its impact on medication adherence in the older adult.
What are the most common problems with medications?
Some types of medication-related problems include: Untreated conditions. Drug use without an indication. Improper drug selection. Dose too low. Dose too high. Adverse drug reactions (side effects) Drug interactions. Failure to receive medications.
What are medication-related problems and why are they important?
Medication-related problems are often mistakenly attributed to aging or underlying health conditions rather than medications. These problems can lead to compromised quality of life, hospitalization, loss of independence or even death. Why are older adults at higher risk for medication-related problems?
Are older adults at increased risk for medication-related problems?
Older adults are at increased risk for experience a problem due to medication for several reasons. They are more likely to suffer from chronic diseases requiring treatment with medications. More medications increase the risk of drug interactions and other medication-related problems.
Is it bad to take multiple medications at once?
Taking multiple medications can be a problem when: 1 a medication does not provide a substantial benefit according to your personal goals and needs, 2 when the medications increase the risk of bothersome or serious side effects, 3 the risk of a medication outweighs the benefits.
What are some complications that may arise from taking multiple medications?
The more medications you are taking, the higher the risk of those drugs interacting dangerously with each other. Multiple medications can cause confusion, lightheadedness and even internal bleeding — all dangerous and injurious conditions.
What are three potential problems associated with medicines?
Some types of medication-related problems include:Untreated conditions.Drug use without an indication.Improper drug selection.Dose too low.Dose too high.Adverse drug reactions (side effects)Drug interactions.Failure to receive medications.
What are the consequences of mixing the medication?
Regularly mixing prescription drugs can lead to drug dependence and addiction. Increased risk of overdose. When mixing prescription drugs you become less aware of your consciousness levels, leading you to take more than your body can cope with. This can result in prescription drug poisoning, coma and death.
What is it called when multiple medications cause symptoms?
Polypharmacy occurs when a patient takes too many medications for their own good. It is most common among seniors and individuals with multiple medical conditions. Since older people metabolize drugs differently, the combined effects of numerous medications can be especially harmful.
What are the medication related problems?
[12–17] Medication-related problems can be classified into eight general categories: untreated indications; improper drug selection; sub-therapeutic dosage; overdose; adverse drug reactions; drug interactions; failure to receive drugs; and drug use without indication.
What are the current issues in medication administration?
Wrong dose, missing doses, and wrong medication are the most commonly reported administration errors. Contributing factors to patient and caregiver error include low health literacy, poor provider–patient communication, absence of health literacy, and universal precautions in the outpatient clinic.
Can you mix medications together?
It's important to take your medication as directed by your doctor or pharmacist. If two meds interact, spacing them apart during the day may not stop them from interacting and could lead to new or worse problems. To avoid an interaction, your doctor may need to change your dose or prescribe a different medication.
Is it safe to take different medicines at the same time?
There are several risks when taking multiple medicines. You may be more likely to have side effects. Because most medicines can have side effects, the more medicines you take, the more likely you will have side effects. Taking certain medicines can also increase the risk for falls.
What drugs should not be combined?
Specifically, drugs that slow down breathing rate, such as opioids, alcohol, antihistamines, CNS depressants, or general anesthetics, should not be taken together because these combinations increase the risk of life-threatening respiratory depression.
What risks are associated with polypharmacy?
Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one.
What is it called when two medications interact?
Drug-drug interactions occur when two or more drugs react with each other. This drug-drug interaction may cause you to experience an unexpected side effect.
Which of the following is a common consequence of polypharmacy?
Patients and caregivers can look for common symptoms of adverse reactions and drug interactions resulting from polypharmacy. The common signs are a loss of appetite, diarrhea, tiredness or reduced alertness, confusion and hallucinations, falls, weakness and dizziness, skin rashes, depression, anxiety, and excitability.
What is the use of multiple drugs?
The use of multiple drugs to treat diseases and other health conditions is known as polypharmacy. This is a growing concern for older adults. Polypharmacy is more common among older adults, many of whom have multiple chronic conditions (MCC), defined as two or more chronic conditions such as arthritis, asthma, chronic obstructive pulmonary disease, coronary heart disease, depression, diabetes, and hypertension. But taking too many drugs can lead to safety concerns. Read on to learn about NIA’s support for polypharmacy research and how our work in this area can help ensure older adults take only those medicines they need to help them live full, healthy lives.
Why do people over 65 take more than one medication?
Adults age 65 and older tend to take more medicines than any other age group because they may have several diseases or other health problems at the same time. Managing multiple medications can be expensive, difficult to track, and hard to manage, especially for those who are homebound or who live in rural areas. In addition, the use of many medications can increase the risk for adverse reactions (problems or side effects caused by a drug) and drug interactions (meaning two or more drugs don’t work well together, causing unintended problems).
What is Optimize study?
The NIA-funded Optimize study tests a deprescribing intervention in a primary care setting for people with Alzheimer’s or a related dementia/MCC with the goal of placing participants on “just right” medication regimens. The study population includes older adults with these diseases who are on five or more medications, as well as their family caregivers. The goal is to refine and test a patient- and caregiver-centric deprescribing intervention that is applicable to multiple types of medications and can be adapted to a variety of health care delivery settings, including hospitals, doctor’s offices, long-term care facilities, pharmacies, and the home. The study also includes an intervention focused on increasing awareness among primary care providers about options and processes for deprescribing for people with Alzheimer’s or a related dementia/MCC and MCI. One aim is to test the effectiveness of the intervention in reducing the number of medications as well as secondary outcomes including patient falls, adverse drug events, hospital and skilled nursing facility utilization, effects on activities of daily living, and the amount of time individuals spend in outpatient office visits.
Why is deprescribing important for MCC?
Researchers are studying deprescribing to reduce these risks and to improve outcomes in older adults with MCC. The goal is to reduce or stop medications that are potentially inappropriate or unnecessary, which can also make the management of medications less of a strain for patients and their families.
What is inappropriate polypharmacy?
Inappropriate polypharmacy — the use of excessive or unnecessary medications — increases the risk of adverse drug effects, including falls and cognitive impairment, harmful drug interactions, and drug-disease interactions, in which a medication prescribed to treat one condition worsens another or causes a new one. Patients may be prescribed medicines that are unlikely to help, potentially harmful, or misaligned with the person’s health goals. Polypharmacy also creates a tremendous burden for patients and their families, who need to understand the purpose of the many prescriptions written by multiple providers, get refills, take each medication at the correct time of day, and recognize side effects.
Why are researchers looking at prescribing patterns?
Researchers are now looking at prescribing patterns to identify systems or clinicians who could benefit from provider education or processes to guide prescribing.
What to do if your medicine is not working?
If you think your medicine is not working as it should, talk to your doctor. You may want to discuss switching to a new medicine or stop taking a current one. Even if you are feeling better, you should not stop taking your prescription drug unless your doctor says it is okay. To have a conversation with your health care provider about deprescribing, consider these tips:
Why are psychiatric patients at higher risk for drug-drug reactions?
Patients with psychiatric illnesses may be at higher risk for the development of certain medical problems because of the physiologic derangements of their psychiatric conditions, or as a result of the somatic treatment used to help them , hence at risk for drug-drug reactions from taking several medications concurrently. Psychopharmacological treatment of psychiatric disorders can be successfully and safely accomplished in the medically ill taking multiple medications when the psychiatrist is cognizant of potential difficulties stemming from both their different medical illnesses and the medications the patient is taking for the treatments of those illnesses by following the principles outlined in ( Table 3 ). Each patient should be assessed for potential disease-related pharmacokinetic and pharmacodynamic changes altering drug distribution, metabolism and clearance, as well as possible drug interactions and vulnerability to the side effects.
Is polypharmacy on the rise?
The incidence of polypharmacy is on the rise, and with the increase comes a greater risk of drug-drug reactions. One survey estimated that patients seeing a psychiatrist may be six times more likely to receive multiple psychotropic medicines compared to patients seen by a primary care physician. This article provides an overview of the extent of polypharmacy, the factors driving the phenomenon and issues clinicians should consider when treating patients who are already taking medicines for other illnesses.
How to keep a list of medications?
Keep a list of the medications you take—with the name of the drug, the dose, how often you take it and why. Put a copy in your medical files at home, carry one in your wallet to show your doctor, and give a copy to a loved one or friend in case you have a medical emergency. “Don’t assume all of your health care providers know about all of your medications,” Merrey says. “A list is essential. It can also help your doctor look for the sources of any side effects or interactions you may be having.”
What to do with all prescriptions?
Toss everything you take (prescriptions, over-the-counter remedies and supplements) into a bag and take it to your annual checkup for a review. “With age, the body absorbs and breaks down medications differently. Your doctor may change the dose of something you’ve used for a long time,” she says.
Why do pharmacists need to have one pharmacy?
“The risk for side effects and drug interactions rises with each additional medication you take,” Merrey explains. “Using one pharmacy keeps your medication records in one place, so the pharmacist can evaluate your risk and work with your doctor to avoid potential problems .”
What is a pill box?
“A pill box with compartments for each day of the week —and for morning, noon and night if you take medications several times a day—lets you know at a glance whether you’ve taken your medicines yet,” Merrey says. “Your pharmacist may be able to fill your pill dispenser for you.”
How many prescriptions do older adults take?
Nearly 40 percent of older adults take five or more prescription drugs. The best approach: “When you’re using several medications, be proactive,” says Jessica Merrey, PharmD, clinical pharmacy specialist at The Johns Hopkins Hospital and certified geriatric pharmacist. “Taking medications as directed by your doctor, getting refills on time, ...
How to remind yourself to take medication?
You can also keep a medication schedule to remind you what to take, and when. (Post it on your refrigerator or inside a kitchen cabinet door .) “Make taking your medications part of your daily routine. Try setting a timer on your phone, watch or alarm clock,” suggests Merrey. “You might always take them after you brush your teeth in the morning, for example.”
Can you run out of medicine?
Running out could allow health conditions to worsen. Check expiration dates frequently and discard any medicines that are out of date. Your pharmacist may even be able to help you get multiple medications on the same refill schedule so that you can make fewer trips to the drugstore, Merrey says.
What are the two things that we need to understand about our bodies when we are taking any type of medication?
The first thing is how our bodies affect the medications– we call this pharmacokinetics. The second thing is how medications affect our bodies – this is called pharmacodynamics. Both of these processes are keys to understanding the benefits and harms of polypharmacy. We consider these two basic processes as we age.
How do drugs affect our bodies?
What a drug does to our bodies is called "pharmacodynamics". Most importantly, how medications affect the condition for which they are prescribed ( e.g. lowering blood pressure or blood sugar) is key. Pharmacodynamic effects can also cause medication interactions. When two or more drugs are combined they may cancel each other out , which may cause one or all of the drugs to have no benefit. On the other hand, when two or more drugs are combined they can increase the effect of one or both , which may result in a greater effect or more side effects (2;3). Drugs can also interact with food, vitamins and herbal products. For example, grapefruit juice affects the enzymes which break down some cholesterol lowering drugs (e.g. atorvastatin). Grapefruit juice acts to reduce the metabolism of the drug and increases the effect on your body, similar to taking a higher dose. The opposite effect can also occur, whereby some herbal products (like St John’s Wort used to treat mild depression), increases the breakdown of other drugs (e.g. blood thinning medications like warfarin). In this example, the warfarin is less available to the body, and has less effect. Another pharmacodynamic problem is that some drugs can aggravate specific diseases. For example, over the counter decongestants that may be taken during flu and cold season can cause blood pressure to rise. If a person has high blood pressure, it may be unsafe to take decongestants. Check with your health care professional first!
How does age affect medication?
As we age, changes which normally occur in these pharmacokinetic processes may affect the risk/benefit profile of medications. This causes older adults to be more vulnerable to medication-related problems. For example, our kidneys work less well as we age; this reduces the ability of the body to eliminate certain medications from our systems (1;2). A medication which is prescribed to a young person may have a different effect as the person ages. This makes it necessary to review the need for, and dose of, that same medication at regular intervals.
What does the research show us about polypharmacy and interactions?
A recent well conducted systematic review showed that adverse effects from medications occur in 58% of people using five medications (1). Older adults are especially susceptible to adverse effects from medications. For example, some medications can cause problems with your memory and other brain functions (called cognitive impairment), urinary incontinence, or impaired balance. This research shows that any of these consequences can increase the risk for falls in an older adult (1). Polypharmacy is also associated with difficulty remembering to take medications on a regular basis (1).
What is the term for the use of multiple drugs or more than are medically necessary?
Polypharmacy, defined as the use of multiple drugs or more than are medically necessary, is a growing concern for older adults.
How many medications are needed for ambulatory care?
Many studies in ambulatory care define polypharmacy as a medication count of five or more medications. However, current medical practice guidelines often require multiple medications to treat each chronic disease state for optimal clinical benefit. Therefore, an elderly patient with at least two disease states, such as heart failure and chronic obstructive pulmonary disease, will usually exceed this arbitrary threshold of > five medications [3]. For example, a 2005-2006 study from the USA reported by Qato et al used a population-based survey of community dwelling persons 57-85 years of age [4]. Overall 37.1% of men and 36% of women between 75 and 85 years of age took at least five prescription medications. Table 1shows the most common prescription medications reported. Moreover, among this older age group taking at least one prescription medication, 47.3% reported the use of an over-the-counter medication and 54.2% a dietary supplement. The use of unnecessary drugs was studied in 128 older male outpatients from the United States [5]. Overall 58.6% of patients took one or more unnecessary prescribed drug. The most commonly prescribed unnecessary drugs are summarized in Table 1.
How does polypharmacy affect health care?
Polypharmacy contributes to health care costs to both the patient and the healthcare system . A retrospective cohort study found that polypharmacy was associated with an increased risk of taking a potentially inappropriate medication and an increased risk of outpatient visits, and hospitalization with an approximate 30% increase in medical costs [10]. Another study conducted in Sweden reported that those taking 5 or more medications had a 6.2% increase in prescription drug expenditure and those taking 10 or more medications had a 7.3% increase [11].
How much do drug interactions affect elderly?
Studies have reported the prevalence of drug-disease interactions to be 15-40% in frail elderly patients. Risk of drug-disease interactions has been shown to increase with increased numbers of medications [21,22]. With patients living longer with more chronic disease states requiring drug therapy, the risk of drug-disease interactions should be a concern for healthcare providers.
Does polypharmacy affect functional decline?
Polypharmacy has been associated with functional decline in older patients. In a prospective study of community-dwelling older adults, increased prescription medication use was associated with diminished ability to perform instrumental activities of daily living (IADLs) and decreased physical functioning [29]. A study using data from the conducted aWomen's Health and Aging Study, found that use of 5 or more medication was associated with a reduced ability to perform IADLs [30]. A prospective cohort of approximately 300 older adults found that patients taking 10 or more medications had diminished functional capacity and trouble performing daily tasks [31]. As part of the Women's Health Initiative Observational study, polypharmacy was associated with incident disability in older women [32]. In patients who have reported falling in the past year, higher medication use was found to be associated with functional decline [33]. Prescribers should be aware of the risk of functional decline in patients taking multiple medications.
Do older adults have polypharmacy?
Older adults with polypharmacy are predisposed to drug- interactions [17]. In a prospective cohort study of older hospitalized adults taking 5 or more medications, the prevalence of a potential hepatic cytochrome enzyme-mediated, drug-drug interaction was 80%. The probability of a drug-drug interaction increased with the number of medications. Specifically, a patient taking 5-9 medications had a 50% probability whereas the risk increased to 100% when a patient was found to be taking 20 or more medications [18]. In a study of community-dwelling elderly adults, almost 50% of patients had a potential drug-drug interaction [19]. Drug-drug interactions are a frequent cause of preventable ADEs and medication-related hospitalizations [16,20]. , Thus practitioners should keep the possibility of a drug-drug interaction in mind when prescribing any new medications.
Is polypharmacy a multiple drug?
There have been numerous studies that have documented the rates of polypharmacy defined as multiple drugs in various settings. Fewer studies have focused on the use of unnecessary drugs.
