Polypharmacy which in simple term implies the concurrent use of multiple medications by a patient, is a growing concern, particularly among the elderly. As age grows, so do the number of ailments; these include common issues like blood pressure, sugar, joint pains, occasional weakness and may extend to severe ailments including cancer or mental impairment. Because of this problem of multiple ailments, elders fall into traps of polypharmacy. There are several reasons for contributing to this problem.
Firstly, self-medication coupled with easy availability of medicines across the counter which is a common thing in India is one of the prime reasons. Secondly, elderly people go to separate doctors (including specialists) at different points of time and do not disclose fully existing medicines and thereby, start consuming new medicines prescribed for fresh problems. Thirdly, as many elderly suffer from chronic ailments, there has been a normal tendency to resort to alternative medicines like Homeopathy or Ayurveda along with allopathy, and that results in additional medicines.
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As a result of all the reasons above, it is seen that multiple-medication or polypharmacy is a commonly prevalent problem particularly in Indian context. It is not a rare occasion to see elderly people consuming as high as 15 to 16 pills a day, which is too high by any standard.
Risks Associated with Polypharmacy
Adverse Drug Reactions (ADRs): The likelihood of experiencing ADRs increases significantly with the number of medications taken. ADRs can range from mild side effects, such as dizziness or nausea, to severe complications like internal bleeding, kidney damage, or life-threatening allergic reactions. In the elderly, even mild ADRs can lead to serious outcomes such as falls or hospitalization. This practice of multiple medication also increases the risk of possible interaction between different drugs thus reducing their efficacy.
Cognitive Impairment: Some medications, particularly those affecting the central nervous system, can contribute to confusion, memory problems, and overall cognitive decline. This can further exacerbate the risk of improper medication management and adherence issues.
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Increased Risk of Falls: Polypharmacy has often been linked to an increased risk of falls and fractures in older adults. Drugs that cause dizziness, low blood pressure, or sedation are common culprits. Falls can lead to severe injuries, loss of independence, and higher mortality rates.
Medication Non-Adherence: Managing numerous medications can be overwhelming, resulting in missed doses, incorrect administration, or complete discontinuation of treatment. This can compromise the effectiveness of therapies and lead to poor disease management.
Controlling Polypharmacy:
The only way forward is to control the menace of polypharmacy or multiple- medication. Some of the major strategies to counter it include:
Patient Education: This is important as elderly patients who resort to polypharmacy must appreciate the risks, both short as well as long-term. Sometimes, elders take it lightly until they land in problem. Hence, patient education is important, and it is the responsibility of all of us to make them understand pitfalls of multi-drug usage.
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Doctor / Pharmacist Education: Though many doctors are aware of the risks of polypharmacy, some of them take it easy. Some doctors, sometimes, may not even insist on knowing current medicines being taken or were being taken before prescribing new drugs. Though such cases are not common, it happens particularly in some remote places or where doctors are semi-qualified or when the doctor is highly pressed for time like in government hospitals. “Structured doctor education” is thus must. Geriatric specialists are motivated and skilled to do this besides taking care of other needs of elderly patients. Pharmacists should also be educated so as not to give all medicines requested by elders and to check the current ones being used by them.
Periodic Review: All elderly should regularly visit specialists of general medicine or geriatric specialists to review the medicines taken. This will help in reducing some of the medicines that might not be needed or regulate the power of some others. This periodic review is particularly important.
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Regulatory Intervention: The only regulatory intervention is to minimize availability of medicines over the counter (OTC). In India this is a serious issue and needs to be taken cognizance of by the regulators.
However, the primary onus lies on elders. They should consult the family physician or geriatric practitioner or an expert doctor giving details of all the medicines and their dosage they are taking. A chart should be maintained and given to doctors along with the period since when they have been consuming these medicines. Often, we find many elders are not conversant with exact names or composition or strength of medicine. The better way is to take all the medicines to the doctor and explain details of their consumption. The practitioner may then suggest way forward regarding what to continue, what to discontinue and / or taper off. It will be an experimental stage, and the patient should follow the advice of the practitioner and see reaction for certain periods say, 2 weeks, and then go back to the doctor again for further views / actions.
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Conclusion
While polypharmacy can sometimes be unavoidable in managing multiple chronic conditions, it is vital to strike a balance to minimize associated risks. Proactive steps such as regular medication reviews, patient education, and deprescribing when appropriate can significantly reduce the negative impacts of polypharmacy. Collaboration between healthcare providers, patients, and caregivers, if any, ensures that elderly individuals receive the safest and most effective treatment, enhancing both quality of life and overall health outcomes. It must be understood that medicines are necessary but there is an optimum level of any consumption of such drugs. Overuse may have completely unexpected adverse effects. Elderly as vulnerable population must be aware of the hazards of polypharmacy and take requisite steps. Family physicians can play an important role in this regard.
Article by Dr A K Sen Gupta, Chief Trustee, My Retired Life Foundation (MRLF).
