Polypharmacy, Adverse Drug Reactions, and Geriatric Syndromes
Section snippets
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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B. Shah has no relationships to disclose.
E. Hajjar is a consultant for Prime Therapeutics.