Author: Nasiya Ahmed, MD
Polypharmacy is the use of multiple medications and/or the administration of more medications that are clinically indicated (Hajjar, Cafiero, & Hanlon, 2007).
Outpatient polypharmacy prevalence is estimated to be 6-42 percent in the elderly population (Slabaugh, Maio, Templin, & Abouzaid, 2011).
Thirty percent of hospital admissions in elderly can be linked to drug related effects and polypharmacy is the 5th leading cause of death for hospitalized elders.
Assessment and Management
Use non-pharmacologic treatment measures first.
Always check medication regimen for drug-drug interactions.
Before initiating any treatment, make sure that the symptom requiring treatment is not a side effect of another drug.
Check drug levels (remember, toxicity can occur at even normal therapeutic levels in the elderly) and always adjust for creatinine clearance.
When discharging a patient, provide a written medication list and if necessary, instructions about medication changes (new medications, discontinued meds, meds that need monitoring).Here are some helpful hints for common drug classes:
Chutka, D.S. (1995). Drug Prescribing in the Elderly. Mayo Clinic Proceedings; 70:685-93.
Fick, D., Semla, T., Beizer, J., Brandt, N., Dombrowski, R., DuBeau, C. E., et al. (2012). American geriatrics society updated beers criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 60(4), 616-631. Retrieved from SCOPUS database.
Hajjar, E.R., Cafiero, A.C., & Hanlon, J.T. (2007). Polypharmacy in elderly patients. American Journal of Geriatric Pharmcotherapeuitcs; 5(4):345-351. Doi:10.1016/j.amjopharm.2007.12.002.
Slabaugh, S.L, Maio, V., Templin, M., & Abouzaid, S. (2011). Prevalence and Risk of Polypharmacy among the Elderly in an Outpatient Setting: A Retrospective Cohort Study in the Emilia-Romagna Region, Italy. School of Population Health Faculty Papers. Paper 44. http://jdc.jefferson.edu/healthpolicyfaculty/44