“Polypharmacy” is a term used to describe the use of four or more medications by a patient. Currently, 44% of men and 57% of women older than age 65 take five or more medications per week; about 12% of both men and women take 10 or more medications per week. These agents include both prescription and over-the-counter preparations, such as vitamin and mineral supplements and herbal products. Concerns about polypharmacy include increased adverse drug reactions, drug interactions, and higher costs. Moreover, there is a concern that polypharmacy can lead to or contribute to urinary incontinence, cognitive impairment and loss of balance leading to falls or fractures.
Older persons react differently to medications than younger persons. Although absorption rates for most drugs don’t change with age, aging alters body fat and water composition: fat stores increase while total body water decreases. These changes can alter therapeutic drug levels, causing greater concentrations of water-soluble drugs and longer half-lives of fat-soluble drugs. When a person is on 2 drugs, there is a 15 percent chance of having an adverse result. The risk increases to 58 percent when a person is taking 5 medications.
Some suggestions for a family member serving as a guardian in addressing this problem include:
- Encourage better communication between the physician, nurse, and pharmacist—everyone should play a role in the process and has a responsibility to prevent potential problems.
- Keep a detailed medication history and drug reconciliation that includes all medications, including over the counter medications, and their original packages for accuracy.
- Look for duplicate medications or medications that do not seem to have any therapeutic benefit. Seniors often take medications for years simply because no one has told them to discontinue their use.
- Simplify the medication regimen by looking at the timing and schedule of treatment. Ask if medications can be taken less frequently or at times when seniors are engaged in an activity that will trigger them to take their medications.
- Guardians should be encouraged to use one pharmacy and coordinate medications with one physician. Also, guardians should be aware that over the counter medications and herbal preparations are just as important to keep track of as prescription medications.