Polypharmacy, Adverse Drug Reactions, and Geriatric Syndromes

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Prevalence of Polypharmacy Defined by Medication Count

Overall medication use has increased recently. According to IMS Health data, the number of prescriptions filled in 2010 was about 4 billion.8 Although making up about 13% of the US population, older adults filled one-third of all prescriptions and 40% of nonprescription medications.9 The average older adult filled 31 prescriptions per year in 2009, twice as many as all other age groups combined.10 Similar disproportionate use has been reported in Canada and the United Kingdom.11, 12

The

Consequences of Polypharmacy

There are many consequences of polypharmacy. Aside from increased direct drug costs, patients are at higher risk for adverse drug reactions, drug interactions, nonadherence, diminished functional status, and various geriatric syndromes.

Drug Regimen Review

Several studies support reviewing drug regimens to reduce polypharmacy.23, 63, 64, 65, 66, 67, 68 These studies have been conducted in inpatient and ambulatory settings, with regimens reviewed by physicians, pharmacists, and/or managed care organizations. The studies are summarized in Table 1.

Principles for Optimizing Drug Use in the Elderly

Extensive medication histories should be obtained at the initial visit and updated with each subsequent encounter. Medication histories should include both prescription and nonprescription medications and

Summary

The elderly are at risk for polypharmacy, which is associated with significant consequences such as adverse effects, medication nonadherence, drug-drug and drug-disease interactions, and increased risk of geriatric syndromes. Providers should evaluate all existing medications at each patient visit for appropriateness and weigh the risks and benefits of starting new medications to minimize polypharmacy.

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References (69)

  • N. Boyle et al.

    Medication and falls: risk and optimization

    Clin Geriatr Med

    (2010)
  • J.T. Hanlon et al.

    A randomized, controlled trial of a clinical pharmacist intervention to improve inappropriate prescribing in elderly outpatients with polypharmacy

    Am J Med

    (1996)
  • A profile of older Americans: 2010

  • Public health and aging: trends in aging — United States and worldwide

    MMWR Morb Mortal Wkly Rep

    (2003)
  • R.B. Stewart et al.

    Polypharmacy in the agedPractical solutions

    Drugs Aging

    (1994)
  • R. Bikowski et al.

    Physician-patient congruence regarding medication regimens

    J Am Geriatr Soc

    (2001)
  • T. Joorgensen et al.

    Prescription drug use, diagnoses, and healthcare utilization among the elderly

    Ann Pharmacother

    (2001)
  • M.M. Fulton et al.

    Polypharmacy in the elderly: a literature review

    J Am Acad Nurse Pract

    (2005)
  • Top-line Market DataIMS Health Web site

  • S.F. Werder et al.

    Managing polypharmacy: walking a fine line between help and harm

    Current Psychiatry Online

    (2003)
  • United States prescription drugsKaiser Family Health Foundation

  • I. Barat et al.

    The consumption of drugs by 75-year-old individuals living in their own homes

    Eur J Clin Pharmacol

    (2000)
  • A. Kennerfalk et al.

    Geriatric drug therapy and healthcare utilization in the United Kingdom

    Ann Pharmacother

    (2002)
  • D. Kaufman et al.

    Recent patterns of medication use in the ambulatory adult population of the United States: The Slone survey

    JAMA

    (2002)
  • D. Fialova et al.

    Potentially inappropriate medication use among elderly home care patients in Europe

    JAMA

    (2005)
  • A. Nobili et al.

    Polypharmacy, length of hospital stay, and in-hospital mortality among elderly patients in internal medicine wardsThe REPOSI study

    Eur J Clin Pharmacol

    (2011)
  • J. Schuler et al.

    Polypharmacy and inappropriate prescribing in elderly internal-medicine patients in Austria

    Wien Klin Wochenschr

    (2008)
  • J.H. Flaherty et al.

    Polypharmacy and hospitalization among older home care patients

    J Gerontol A Biol Sci Med Sci

    (2000)
  • P.D. Sloane et al.

    Inappropriate medication prescribing in residential care/assisted living facilities

    J Am Geriatr Soc

    (2002)
  • H.L. Lipton et al.

    The impact of clinical pharmacists' consultations on physicians' geriatric drug prescribingA randomized controlled trial

    Med Care

    (1992)
  • M.A. Steinman et al.

    Polypharmacy and prescribing quality in older people

    J Am Geriatr Soc

    (2006)
  • E.R. Hajjar et al.

    Unnecessary drug use in frail older people at hospital discharge

    J Am Geriatr Soc

    (2005)
  • J.T. Hanlon et al.

    Inappropriate medication use among frail elderly inpatients

    Ann Pharmacother

    (2004)
  • J.H. Gurwitz et al.

    Incidence and preventability of adverse drug events among older persons in the ambulatory setting

    JAMA

    (2003)
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    B. Shah has no relationships to disclose.

    E. Hajjar is a consultant for Prime Therapeutics.

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