Polypharmacy among the elderly
The use of multiple drugs in a younger and disease free individual calls for mindful consideration what more to the elderly people. Aside from the physiologic changes, adverse drug events are more likely to occur in the elderly because they undergo several treatments under the care of different physicians. There is a higher risk of adverse drug events as the number of medicines that an elderly patient takes in increases. In fact, estimated drug interactions can occur from 6% in patients taking two drugs a day to 50% in those taking five daily. (Lin, 2004)
Elderly are also more likely to take medications that are “unnecessary, ineffective and inappropriately prescribed”. In a study by Simon et al (2005), 29% of 150,000 elderly patients had used at least one out of 33 potentially inappropriate medicines. Aspirin (anticoagulant), Digoxin (digitalis glycoside) and lipid lowering agents were found to be the top three most inappropriate and underused medications. (Steinman, et al 2006) Meanwhile, those who use dietary and herbal products also have higher risks for drug interactions such that these products itself are mixtures of multiple active ingredients and some are not subject to regulatory requirements.
The simplest and most efficient intervention to this problem is to stay vigilant to any sudden change in the elderly patient. Record all the medicines and supplements that they take in and educate the family on drug risks and contraindications. Technological innovations that include electronic prescription and electronic medical records are also ways that may pose a possible solution to a “pill that overkills”.
Sources: Lin P (2004) Drug Interactions. A method to the madness. Perspectives in Cardiology 20(10), 20
Simon, S. R., Chan, K. A., et al. (2005). Potentially inappropriate medication use by elderly persons in U.S. health maintenance organizations, 2000 – 2001. J Am Geriatr Soc, 53(2), 227.
Steinman et al (2006). Polypharmacy and Prescribing Quality in Older People. J Am Geriatr Soc, 54: 15-16