Danger of Polypharmacy in the Elderly by Anita Kamiel, R.N., M.P.S.

Definition

Polypharmacy is a term used for taking five or more drugs concurrently and this trend is on the rise. While this is a cause for alarm in the young, in the elderly, who usually take a panoply of medications prescribed to them by their stable of specialists along with their internist or geriatrician, the effects can be extremely serious. With so many doctors and healthcare professionals managing the patient, it is easy to both rack up the number of drugs at play as well as fall into the “prescribing cascade” where drugs are prescribed to counteract the side effects of another prescribed drug.

Risks in the Elderly

As with most things, the problem of drug interaction is more acute in the elderly than their younger counterparts. If dizziness is a side effect, as it is with beta blockers, and a fall occurs, the results can be catastrophic as compared to someone younger. In fact, higher medication use in the elderly has been cited as responsible for some falls and doctors have been advised to avoid medications that have been linked to falling.

Older patients seem to use their own discretion when taking their medications. They don’t easily cede their independence and it extends to this area of their lives as well. The senior patient may also be loath to tell the doctor about a complementary therapy or remedy having experienced a closed-minded or judgmental reaction it in the past.

Rising Trend...

According to a Harvard study, polypharmacy has seen a 70% increase over the last 12 years. A longitudinal study in JAMA Internal Medicine found that more than 33% are taking five or more medications, 66% are taking dietary supplements and 40% are taking over the counter drugs.

In 2006, 8% of seniors were at serious risk for drug interaction, but that number rose to over 15% in 2011. Adverse drug interactions include combining aspirin with the blood thinner Plavix. Taken together there is an increased risk of abdominal bleeding. Taking fish oil for heart health combined with the blood thinner Coumadin can also cause bleeding.

Most elderly patients don’t bother to tell their doctors about the non-prescription drugs or supplements they are taking for the simple reason that their doctor often neglects to either ask them about it or inform them that there could be risks of drug interaction. If the elderly will be choosing which medication they want to take (or can afford – a whole other topic), it is important to educate them about the purpose of each and the possible interactions, so they, their families and doctors can make informed decisions.

Communication & Follow-up Is Key

A serious problem is that medications are very often prescribed by specialists who don’t necessarily communicate with each other. A clinical pharmacist specializing in geriatric care can help. They are often the repository for all the prescriptions for the patient and can be a central clearinghouse. They can perform a drug reconciliation to make sure the patient is not combining substances with negative interactive effects. Consult Beer’s List put out by the American Pharmacists Association for drugs not to use in older adults. There is a handy list of “Tips on Polypharmacy Management” available through the ClevelandClinic.org.

Another problem is once we start medications, we almost never stop them. Money is poured into efficacy tests for a course of drug treatment, but we almost never study how and when treatment is to end. A study out of the Veteran’s Affairs Hospital showed that 44% of elderly patients were actually given at least one unnecessary medication upon discharge.

In the meantime, go along with your senior loved one to the next checkup or doctor visit and bring every prescription and non-prescription over the counter remedy or supplement with you so you can do a comprehensive review. It will be a good time to re-visit the necessity of the medications as well as a time to tweak dosages.

If elderly patients are confused about what to take or are in the beginning stages of dementia, it’s easy to mismanage the arsenal of medications they are prescribed or recommended to take. A caregiver or family member must step in to avert what can sometimes become a life threatening disaster.

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Anita Kamiel, RN, MPS, is the founder and owner of David York Home Healthcare Agency, licensed by the State of New York. She holds a master’s degree in gerontological administration and is fully acquainted with all factors related to eldercare services and the latest guidelines for seniors. Thirty years ago, she realized the need for affordable, quality home health aide services provided and supervised by caring individuals. You can contact her at 718-376-7755 or at www.davidyorkagency.com. David York Agency is also on Facebook, Twitter, Google+, and LinkedIn.

Alcohol Abuse Alarm Bell

Alcohol abuse seems to be the most common form of substance abuse in the elderly and is on the rise among this age group. According to Dr. Richard A. Friedman’s article in the New York Times, “A Rising Tide of Substance Abuse,”  there seems to be much cause for alarm as the baby boomers move into the senior citizen age bracket. Baby Boomers have already experimented with alcohol and drugs and do not stigmatize their use as much as previous generations. With estimates of 14-20% of the elderly population suffering from substance abuse or mental disorders or both, the mental health system is in danger of collapsing with all the new patients poised to enter the system. 


Senior citizen substance abuse and caregiversMany, who did not formerly have a problem with alcoholism or substance abuse, turn to it in later years as a way to cope with the loss, loneliness and isolation that often accompanies old age. They also become addicted to substances to ease their physical pain. Women seem to be outpacing men in their abuse of anti-anxiety, sleeping pills and opiate painkillers. 
 

A complicating factor in this whole scenario is that the elderly have a reduced ability to metabolize the alcohol they consume, so the alcohol stays in their bloodstream for a lot longer than it did when they were younger. Seniors need to adjust for this fact and not think that they could drink as much as they did when they were younger. 


More thorough screening by healthcare professionals and attention to the psychological factors triggering this elderly substance abuse are urgently needed. David York Agency is fully acquainted with all factors related to eldercare services and is always available to set up a senior care plan taking the whole patient into account.