Polypharmacy in the Elderly

As we age, we sometimes start collecting illnesses and diseases.

These can include things like high cholesterol, high blood pressure, or even insomnia. Each of these illnesses often requires medication, sometimes prescription and sometimes over-the-counter, to treat it. These medications can begin to add up and lead to polypharmacy, especially in older adults. 

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What is Polypharmacy?

Polypharmacy is using multiple medications or drugs. Some definitions of polypharmacy refer only to prescription medications, while others include over-the-counter drugs and even dietary supplements in the definition. In most cases though, polypharmacy refers to taking five or more prescription medications on a regular basis. The important fact is this: patients, particularly older adults, who take five or more prescription medications on a regular basis have higher risks of overmedication, oversedation, and side effects. 

Polypharmacy and the Elderly

Polypharmacy tends to happen with elderly adults because they often have multiple chronic health conditions they are managing. These health conditions could include things like high blood pressure, diabetes, arthritis, high cholesterol, asthma and COPD. Elderly adults are also not always reassessed for chronic conditions. Older adults also have a higher probability of ending up in the emergency room, where medication may be added and quickly become unnecessary. 

Polypharmacy in elderly adults is concerning because seniors can sometimes have multiple illnesses or medical conditions that require medication and multiple doctors who manage all those conditions. While of course a patient may take multiple medications for absolutely valid reasons, and all those drugs are correctly and effectively monitored by their care team, it is still worth knowing when to be concerned. Some signs that a medication list may need a closer look include:

• Medications are not fully needed, or were needed in the past and are no longer necessary
• There is overlap in how the medications work
• Medications interact with each other
• A patient is receiving medications from multiple healthcare providers

Again, polypharmacy does not always mean something is wrong, it just means the patient and their medications should be closely monitored. 

Dangers of Polypharmacy

Some risks of polypharmacy include:

• Drug-to-drug interactions, in which one medication affects another
• Drug-to-disease interactions, in which a medication for one disease makes another disease worse
• Oversedation, which can cause dizziness and confusion and increase risks of falls or car accidents. Painkillers, medications for anxiety, and antihistamines can all lead to oversedation. 
• Dizziness and loss of balance is a side effect of many medications, which can be exacerbated by other medications. 

Symptoms of polypharmacy to watch out for include:

• Confusion or cognitive problems
• Weakness or dizziness
• Loss of appetite
• Skin rashes
• GI problems like constipation or diarrhea 
• Anxiety or depression

Taking five or more medications is not a bad thing, and it is often medically necessary. There is no reason to feel like you need to “get off” a medication simply for the sake of not being on it. Rather, make sure you frequently review your medication list with your primary healthcare provider and instead of just making a list, discuss why you are taking each medication. Make sure they are still necessary and not interacting with each other. With monitoring, polypharmacy can be safe and effective.