Polypharmacy, defined as taking multiple medications, is common in the elderly population. Over half of people aged 65 and older take 5-9 medications, while 18% take 10 or more. The prevalence is higher in women due to longer lifespans and more frequent doctor visits. Polypharmacy can lead to adverse drug events, with risk exponentially increasing with more medications. Common signs include dizziness, confusion, and fatigue. Solutions include reducing unnecessary medications, simplifying dosing schedules, and increasing medication management support and provider education to curb this significant health issue in aging populations.

1. Óvári Ignác

2. Contents
 Definiton
 Prevalence
 Differences
 Why?
 Signs
 Outcomes
 ADE
 Solutions

3. Definition
Wide range of definitions
 Generally defined as „ Condition in
which patients receive too many
medications, too long, or exceedingly
high doses „

4. Definition
 Use of several drugs or medicines together
in the treatment of disease, suggesting
indiscriminate, unscientific, or excessive
prescription
Stedman’s Medical Dictionary
 Use of four or more medications
DRUG
is any substance that affects the physical and
mental functioning
of a living organism

5. Prevalence
 Between 55- 59% of people age 65 or
older take 5-9 medications
 18% take ten or more (excessive
polypharmacy)
 Common in the elderly
 40% take ≥5 drugs/week
 12% take ≥10 drugs/week

6. Young Elderly
Drug
absorption
Faster Slower
Metabolism Faster Slower
Excretion Faster Slower
Differences

7. Gender and Polypharmacy
 Women consume more medication than
men
 Women live longer than men
 Among those that are >80 women are
twice as numerous than men
 Women attend primary care visits more
often

8. Commonly Prescribed
Medications
 GI preparations (laxatives)
 Cardiovascular drugs
 Antihypertensives
 Anti-inflammatory
 Sedatives

9. Why?
 The more the providers and visits, the
more the # meds patient takes
 2/3 of all physician visits end with a
prescription
 Expectations to receive medication
 Self-treatment

10. Signs of Polypharmacy
 Taking multiple medications in the
elderly often mimic side effects that
produce the image of growing old:
 Dizziness
 Confusion
 Fatigue
 Insomnia
 Urinary Incontinence

11. Negative Outcomes
 Diabetes
 Loss of balance leading to falls/fractures
 Depression
 Hypertension
 Osteoarthritis
 Cognitive Impairment
 Soul
 Geriatric “Syndromes”
 Adverse Drug Events

12. Adverse Drug Events
 WHO: “Unintended and undesired
effects of a medication at a normal
dose”
 Risk is 15% with two medications
 Risk increases to 58% with 5 meds
 Risk increases to 82% with ≥ 7 meds
 Additional medications lead to greater
incidence of drug interactions

13. PercentofPatients
withADE
# of Drugs Taken
Nolan L. JAGS. 1988;36(2):142-149.
Exponential Relation Between
Polypharmacy and ADEs

14. In USA:
ADE estimated to be between 4th
and 6th leading cause of death.
Lazarou JAMA 1998

15. Always Remember
“Prescribing cascade”- a drug
added to treat (mistakenly)
the ADE of another drug

17. Solutions
  # of drugs, prescribers
 Once-daily or twice-daily dosing
 Pill boxes
 Medication reminder charts
  frequency of clinic visits

18. Solutions
 Professional, educational activities for providers or
patients
 Polypharmacy clinic
 Review medication
 Avoid errors- prescribe carefully
 Give verbal and written instructions
 Simplify
 Understand obstacles (cost, memory loss…)
 Make sure there is good follow up
 e-prescribing systems

19. Tools to Help Decrease
Polypharmacy
 Beers Criteria
 STOPP Criteria
 START Criteria
 Divided into 3 categories
 those to avoid in older adults
 those to avoid in older adults with certain diseases
and syndromes that the drugs listed can exacerbate
 medications to be used with caution

20.  START was developed in 2007
 List organized by physiological system
 Intended to identify potentially beneficial
medication omissions
 STOPP (2008)
 List of potentially inappropriate medications
(PIMs) and is organized by physiological
systems
 drug-drug interactions,
 drug-disease interactions
 medication that will increase a patient’s risk
of falls

21. Summary
 Common in the elderly
 Especially women
 Visits/Self-treatment
 Signs of Polypharmacy
 Adverse Drug Events
 Solutions

22. Thank you for your
attention!
Questions?