Introduction
Polypharmacy is a disturbing health issue that happens to be very common among the elderly. It is fraught with many risks and consequences and can lead to different health problems. To avoid such outcomes polypharmacy should be strictly controlled.
What is polypharmacy?
There is no standard definition of polypharmacy, but the term usually refers to the fact of taking several medications at the same time, some of which can be unnecessary and not clinically indicated. Thus, “polypharmacy is not synonymous with inappropriate prescribing, but the two are nevertheless strongly associated” (Payne & Avery, 2011, p. 84).
Sometimes this problem arises because of inadvertence when a person is taking a drug just by force of habit, even though there is no need for it anymore. Polypharmacy can also be caused by multiple medical conditions when different treatment approaches are required (Hajjar, Cafiero, & Hanlon, 2007). Finally, there is no doubt that both of these situations are more frequent among the elderly.
Statistics among elderly
According to a large-scale study in Europe, which was conducted among 2707 elderly receiving home care, nearly 50% of them were taking 6 or even more medications at the same time (Fialova et al., 2005). Another study revealed that 30% of women and more than 20% of men were taking at least three drugs per day. Moreover, nearly 5% of them complained about different side effects (Arslan, Atalay, & Gökçe-Kutsal, 2002).
The risks and consequences of polypharmacy
The main danger of taking several drugs at the same time is a higher probability of side effects. In such kind of situation, it is also extremely difficult to find out which one of the drugs has become a cause. Moreover, because of drug interactions, the effects of medications, both wanted and unwanted, can change.
Besides, it is usually a burden for a patient to keep in mind when and how often to take a prescribed drug. If there are several of them it is even more complicated, and the risk of non-adherence increases.
The consequences of all mentioned above are unpredictable and can even cause different diseases.
How can case managers help the elder to stay safe?
To prevent the adverse effects of polypharmacy case manager should, first of all, check whether all medications a patient takes are necessary. All over-the-counter drugs that were not clinically indicated should be excluded. Since a patient is usually not the best informant, it is better to contact his physician. It is also imperative to know what medications are incompatible to avoid dangerous drug interactions and the occurrence of side effects.
When the list of drugs is already agreed with a physician, a care manager should make a strict schedule of treatment for a patient to know when and what drug to take. This approach will greatly simplify the patient’s medication regimen. Finally, a care manager should keep a detailed drug reconciliation history and realize how long one or another drug is needed to be taken. A lot of elderly continue their treatment only because nobody tells them to discontinue the drug use.
By paying more attention to their patients, case managers can prevent the consequences of polypharmacy, avoid unnecessary hospitalization and, finally, make patients’ lives simpler and safer.
References
Arslan, S., Atalay, A., & Gökçe-Kutsal, Y. (2002). Drug use in older people. Journal of the American Geriatrics Society, 50(6), 1163-1164.
Fialova, D., Topinkova, E., Gambassi, G., Finne-Soveri, H., Jonsson, P. V., Schroll, M.,…Bernabei, R. (2005). Potentially inappropriate medication use among elderly home care patients in Europe. Journal of the American Medical Association, 293(11), 1348-1358.
Hajjar, E. R., Cafiero, A. C., & Hanlon, J. T. (2007). Polypharmacy in Elderly Patients. The American Journal of Geriatric Pharmacotherapy, 5(4), 345-351.
Payne, R. A., & Avery, A. J. (2011). Polypharmacy: one of the greatest prescribing challenges in general practice. British Journal of General Practice, 61(583), 83-84.