Journal Club- Polypharmacy A Global Risk Factor for Elderly People

World Health Organization has evaluated that in every nine people there is one elderly people, i.e., of age 60 years or older. This value is to be expected to increase to one in five people by 2050 accounting for about half of the total growth of the world population.

Ageing population is not just a concern for high-income countries. The majority of older people already live in low- and middle-income countries, and this is where some of the fastest rates of ageing are occurring. This demographic transition in the elderly population constitutes a significant challenge for health authorities worldwide as with advancing age multiple chronic diseases such as hypertension, diabetes mellitus, arthritis, chronic heart disease, renal diseases, etc. are associated. As a result of which elderly people tend to take multiple medications in a day that can be referred to as polypharmacy.

There is no as such standard definition of polypharmacy. It can be explained as the use of multiple medications generally referred to five or more prescribed drugs per day and/or the administration of more medications than are clinically indicated, representing unnecessary/unwanted drug use.

Polypharmacy is an area of concern for elderly because of several reasons. Elderly people are at a greater risk for adverse drug reactions (ADRs) because of the metabolic changes and reduced drug clearance associated with ageing; this risk is furthermore exacerbated by increasing the number of drugs used. Potential of drug-drug interactions is further increased by use of multiple drugs. In a case–control study carried out among old age people, polypharmacy was found to be an independent risk factor for hip fractures.

Polypharmacy may sometimes lead to "prescribing cascades."  Prescribing cascade is said when signs and symptoms (multiple and nonspecific) of an ADR is misinterpreted as a disease and a new treatment/drug therapy is further added to the earlier prescribed treatment to treat the condition. The symptoms caused by polypharmacy is unfortunately usually demented with the normal aging signs and symptoms, which can be: Tiredness, sleepiness, or decreased alertness, constipation, diarrhea etc.

Evaluation of polypharmacy is of important concern in an elderly patient so as to avoid all the possible adverse effects. Comprehensive medication review and risk assessment should be carried out by interdisciplinary team to identify the polypharmacy and its adverse effects. It can be carried out using various tools like Assess Review Minimize Optimize Reassess, Screening Tool to Alert Doctors to the Right Treatment.

To reduce the incidence and adverse effects of polypharmacy medication regimes of elderly patients should be evaluated monthly. A single agent/drug should be prescribed instead of multiple drugs for the treatment of a single condition, if possible. Medications should be started with the lower drug dosage where clinically indicated and if required incremental increase can be done.

Identifying and avoiding the polypharmacy can lead to better outcomes in the elderly patients and also helps in improving the quality of life. Medication review is an essential part in the elderly patient to avoid adverse effects that can be caused due to polypharmacy.