Protect older adults from polypharmacy hazards

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Excerpt

POLYPHARMACY can be simply defined as the use of multiple medications, including over-the-counter (OTC) products and dietary/herbal supplements, by one patient. The minimum number varies, but taking five or more medications is generally considered polypharmacy.1 Polypharmacy is common in older adults who may take medications to treat various health disorders, including hypertension, depression, constipation, gastroesophageal reflux disease, insomnia, and various other chronic diseases such as diabetes. Many older adults also take anticoagulation to prevent thromboembolism. While these medications can improve health when taken individually, together they can trigger adverse reactions and may be associated with increased mortality and morbidity.1
Drug interactions are common in older adults taking a polypharmacy regimen. In one study of older hospitalized adults taking five or more medications, the probability of a potential hepatic cytochrome enzyme-mediated, drug-drug interaction was 80%. The probability increased to 100% in patients taking 20 or more medications.2
Factors contributing to polypharmacy include underreporting of signs and symptoms related to polypharmacy by the patient, use of multiple prescribers, use of multiple pharmacies, taking another person's medications, limited time for discussions between patients and providers regarding medications, and limited knowledge of geriatric pharmacology by providers.1-3
In older adults, adverse drug reactions may be overlooked or misinterpreted because they're nonspecific and/or mimic common complaints of aging. Examples include dizziness, confusion, fatigue, nervousness, depression, and incontinence. The following scenario illustrates the problem of polypharmacy and potential consequences.
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