Polypharmacy in the Elderly: the Need for Concern and Strategies for its Control

Polypharmacy in the Elderly: the Need for Concern and Strategies for its Control

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Author(s): ABDULRAHEEM Ibraheem Shola, Adeoye Adegboye

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DOI: 10.18483/ijSci.745 521 1043 11-18 Volume 4 - Jul 2015

Abstract

In the last three decades, problems related to aging, multi-morbidity, and polypharmacy have become a prominent issue in global healthcare. In this study, Polypharmacy is defined as a concomitant use of five or more drugs simultaneously and/or the administration of more medications than are clinically indicated, representing unnecessary drug use. The purpose of this study was to describe and quantify the magnitude of polypharmacy, analyze the factors associated with this practice among elderly and suggest control measures for its reduction. Other objectives include creating awareness about the risks of multiple drug use in ageing population and propose practical recommendations/interventions regarding rational drug use for elderly age groups. Materials for this study were obtained from a search of the MEDLINE database and International Pharmaceutical Abstracts to identify articles in people aged 60 years and above. A combination of the search terms like polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged were used. This study found out that polypharmacy is a common problem and a known risk factor for important morbidity and mortality in the elderly. Many medications are associated with negative health outcomes, but more research is needed to delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks associated with polypharmacy and fully evaluate all medications at each patient visit in order to prevent polypharmacy from occurring.

Keywords

Polypharmacy, Elderly, Strategies, Concern, Control

References

  1. Ramos LR. Fatores determinantes do envelhecimento saudável em idosos residentes em centro urbano: Projeto Epidoso, São Paulo. Cad Saúde Pública 2003; 19: 793-8. http://dx.doi.org/10.1590/s0102-311x2003000300011
  2. United Nations. 1985. The World Ageing Situation: Strategies and Policies. New York.
  3. Coelho Filho JM, Marcopito LF, Castelo A. Medication use patterns among elderly people in urban area in Northeastern Brazil. Rev Saude Publica 2004; 38: 557-64.
  4. Qato DM, Alexander GC, Conti RM, Johnson M, Schumm P, Lindau ST. Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States. JAMA 2008; 300: 2867-78. http://dx.doi.org/10.1001/jama.2008.892
  5. Ribeiro AQ, Rozenfeld S, Klein CH, César CC, Acurcio Fde A. Survey on medicine use by elderly retirees in Belo Horizonte, Southeastern Brazil. Rev Saúde Pública 2008; 42: 724-32. http://dx.doi.org/10.1590/s0034-89102008005000031
  6. Flores LM, Mengue SS. Uso de medicamentos por idosos em região do sul do Brasil. Rev Saúde Pública 2005; 39: 924-9. http://dx.doi.org/10.1590/s0034-89102005000600009
  7. Kaufman DW, Kelly JP, Rosenberg L, Anderson TE, Michell AA. Recent patterns of medication use in the ambulatory adult population of the United States. JAMA 2002; 287: 337-44. http://dx.doi.org/10.1001/jama.287.3.337
  8. Safran DG, Neuman P, Schoen C, Kitchman MS, Wilson IB, Cooper B et al. Prescription drug coverage and seniors: findings from a 2003 national survey. Health Aff (Millwood) 2005; Suppl Web Exclusives: W5-152-W5-166.
  9. Rozenfeld S, Fonseca MJM, Acurcio FA. Drug utilization and polypharmacy among the elderly: a survey in Rio de Janeiro City, Brazil. Pan Am J Public Health 2008; 23: 34-43. http://dx.doi.org/10.1590/s1020-49892008000100005
  10. Shepler SA, Grogan TA, Pater KS. Keep your older patients out of medication trouble. Nursing 2006;36(9):44-7. (PMID:16951619). http://dx.doi.org/10.1097/00152193-200609000-00033
  11. Planton, J. & Edlund, B. (2010) Strategies for reducing polypharmacy in older adults. Journalof Gerontological Nursing. 36(1), 8-12. http://dx.doi.org/10.3928/00989134-20091204-03
  12. Frazier, S. (2005). Health outcomes and polypharmacy in elderly individuals: an integrated http://dx.doi.org/10.3928/0098-9134-20050901-04
  13. literature review. Journal of Gerontological Nursing. 31(9), 4-11. http://dx.doi.org/10.3928/0098-9134-19871101-08
  14. Brager, R., & Sloand, E. (2005). The spectrum of polypharmacy. Nurse Pract, 30, 44-50 http://dx.doi.org/10.1097/00006205-200506000-00008
  15. Viktil, K. K., Blix, S. H., Moger, A. T., & Reikvam, A. (2007). Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug- related problems. Brit. Jou. Clin Pharmacol., 63(2), 187-195. http://dx.doi.org/10.1111/j.1365-2125.2006.02744.x
  16. Hilmer, S. N. (2008). The dilemma of polypharmacy. Retrieved from http://www.australianprescriber.com/magazine/31/1/2/3.l.v. 16/08/2014
  17. Aparasu, R., Mort, J., Brandt, H. (2005). Polypharmacy trends in office visits by the elderly in The United States, 1990 and 2000. Research in Social and Administrative Pharmacy, 1,446-459. http://dx.doi.org/10.1016/j.sapharm.2005.06.004
  18. Simon, S. R., Chan, K. A., et al. (2005). Potentially inappropriate medication use by elderly persons in U.S. health maintenance organizations, 2000 – 2001. J Am Geriatr Soc, 53(2), 227. http://dx.doi.org/10.1111/j.1532-5415.2005.53107.x
  19. Lim, W. K., & Woodward, M. C. (1999). Improving medication outcomes in older people. Aust J Hosp Pharm, 29(2), 103.
  20. Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 2005;17(4):123-32.(PMID:15819637).
  21. Corcoran, M. E. "Polypharmacy in the older patient with cancer." 1997. www.moffitt.usf.edu/pubs/ccj/v4n5/article5.html Retrieved 10th July 2014.
  22. Lin, P. (2004). Drug interactions: A method to the madness. Perspectives In Cardiology, 20(10), 20.
  23. Fulton, M. M., & Allen, E. R. (2005). Polypharmacy in the elderly: A literature review. J Am Acad Nurse Pract, 17(4), 123. http://dx.doi.org/10.1111/j.1041-2972.2005.0020.x
  24. Beers, M. H. (Ed.) "The Merck manual of geriatrics (3rd ed.), Section 1, Basics of geriatric care, Chapter 6, Clinical pharmacology."2005.www.merck.com/mrkshared/mmg/sec1/ch6/ch6a.jsp 4TH August 2014.
  25. Barat I, Andreasen F, Damsgaard E. The consumption of drugs by 75-year-old individuals living in their own homes. Eur J Clin Pharmacol 2000; 56: 501–509. http://dx.doi.org/10.1007/s002280000157
  26. Passarelli MC, Jacob-Filho W, Figueras A. Adverse drug reactions in an elderly hospitalised population: inappropriate prescription is a leading cause. Drugs Aging. 2005;22(9):767-77. http://dx.doi.org/10.2165/00002512-200522090-00005
  27. Coelho Filho JM, Marcopito LF, Castelo A. Perfi l de utilização de medicamentos por idosos em área urbana do Nordeste do Brasil. Rev Saude Publica. 2004;38(4):557-64. http://dx.doi.org/10.1590/s0034-89102004000400012
  28. Veehof LJG, Stewart RE, Haaijer-Ruskamp FM, Jong BM. The development of polypharmacy. A Longitudinal study. Fam Pract. 2000;17(3):261-7. http://dx.doi.org/10.1093/fampra/17.3.261
  29. Fulton MM, Allen ER. Polypharmacy in the elderly: a literature review. J Am Acad Nurse Pract 2005;17(4):123-32.(PMID:15819637).
  30. George CJ, Jacobs LG. Geriatrics medication management rounds: a novel approach to teaching rational prescribing with the use of the medication screening questionnaire. J Am Geriatr Soc http://dx.doi.org/10.1111/j.1532-5415.2010.03231.x
  31. 2011;59(1):138-42. (PMID:21198464).
  32. Lees J, Chan A. Polypharmacy in elderly patients with cancer:clinical implications and management. Lancet Oncol 2011;12(13):1249-57. (PMID:21741307).91. Ay P, Akici A, Harmanc H. Drug utilization and potentially inappropriate drug use in elderly residents of a community in Istanbul, Turkey. Int J Clin Pharmacol Ther 2005;43(4):195-202. (PMID:15966466).
  33. Fick DM, Cooper JW, Wade WE, et al. Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts. Arch Intern Med 2003;163(22):2716-24. (PMID:14662625). http://dx.doi.org/10.1001/archinte.163.22.2716
  34. van der Hooft CS, Jong GW, Dieleman JP, et al. Inappropriate drug prescribing in older adults: the updated 2002 Beers criteria–a population-based cohort study. Br J Clin Pharmacol 2005;60(2):137-44. (PMID:16042666). http://dx.doi.org/10.1111/j.1365-2125.2005.02391.x
  35. Bao Y, Shao H, Bishop TF, Schackman BR, Bruce ML. Inappropriate medication in a national sample of US elderly patients receiving home health care. J Gen Intern Med 2012;27(3):304-10. (PMID:21975822) http://dx.doi.org/10.1007/s11606-011-1905-4
  36. Fick DM, Mion LC, Beers MH et al. Health outcomes associated with potentially inappropriate medication use in older adults. Res Nurs Health 2008;31:42–51. http://dx.doi.org/10.1002/nur.20232
  37. Hanlon JT, Schmader KE, Samsa GP et al. A method for assessing drug therapy appropriateness. J Clin Epidemiol 1992;45:1045–1051.
  38. Lau DT, Kasper JD, Potter DE et al. Hospitalization and death associated with potentially inappropriate medication prescriptions among elderly nursing home residents. Arch Intern Med 2005;165:68–74. http://dx.doi.org/10.1001/archinte.165.1.68
  39. Wright RM, Roumani YF, Boudreau R et al. Effect of central nervous system medication use on decline in cognition in community-dwelling older adults: Findings from the Health, Aging and Body Composition Study. J Am Geriatr Soc 2009;57:243–250. http://dx.doi.org/10.1111/j.1532-5415.2008.02127.x
  40. Fu AZ, Liu GG, Christensen DB. Inappropriate medication use and health outcomes in the elderly. J Am Geriatr Soc 2004;52:1934–1939. http://dx.doi.org/10.1111/j.1532-5415.2004.52522.x
  41. Karch FE, Lasagna L Adverse drug reactions: a critical review. JAMA 1975;234:1236-41 http://dx.doi.org/10.1001/jama.1975.03260250028021
  42. Manncssc CK, Derkx FH, de Ridder MA, et al Adverse drug reactions in elderly patients as contributing factor for hospital admission∶ cross sectional study Br Med J 1997;315∶ 1057-58 http://dx.doi.org/10.1136/bmj.315.7115.1057
  43. Manncssc CK, Derkx FH, de R1ddcr MA, et al. Contribution of adversc drug reactions to hospital admission of older patients Age Ageing 2000;29∶ 35-39 http://dx.doi.org/10.1093/ageing/29.1.35
  44. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients∶ a meta-analysis of prospective studies JAMA1998;279∶ 1200-205 http://dx.doi.org/10.1001/jama.279.15.1200
  45. Wiffen P, Gill M, Edwards J, et al Adverse drug reactions in hospital patients Bandolier Extra2002;l-15
  46. Rawlins MD Adverse drug reactions BMJ 1981;282∶ 974-76 http://dx.doi.org/10.1136/bmj.282.6268.974
  47. Rawhns MD, Thompson JP Pathogenesis of adverse drug reactions
  48. ln Textbook of adverse drug reactions, ed Davies DM. Oxford: oxford Univcrsity Prcss,1977;44
  49. Park BK, Coleman JW. The immunological basis of adversc drug reactions∶ a report on a symposium held in Livcrpoo1on 6th April 1988 BrJ Clinical Pharmacol 1988;26∶ 491-95 http://dx.doi.org/10.1111/j.1365-2125.1988.tb05287.x
  50. Suh DC, Woodall BS, Shin SK, et aI Clinical and economic impact of adverse drug reactions in hospitalizcd patients Ann Pharmacothcr 2000∶ 34∶ 1373-79
  51. Bowman L, Cadstcdt BC, Hancock EF et al. Adverse drug reaction (ADR) occurrence and evaluation in the elderly inpatients Pharmacoepidcmiol Drug Saf 1996;5∶ 9-18
  52. Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc 2006;54(10):1516–23. http://dx.doi.org/10.1111/j.1532-5415.2006.00889.x
  53. Hilmer SN, Gnjidic D. The effects of polypharmacy in older adults. Clin Pharmacol Ther 2009;85(1):86–98. http://dx.doi.org/10.1038/clpt.2008.224
  54. Kuijpers MA, van Marum RJ, Egberts AC, Jansen PA. Relationship between polypharmacy and under-prescribing. Br J Clin Pharmacol 2008;65(1):130–3.
  55. Simonson W, Feinberg JL. Medication-related problems in the elderly. Defi ning the issues and identifying solutions. Drug Aging 2005;22(7):559–69. http://dx.doi.org/10.2165/00002512-200522070-00002
  56. Beer C, Hyde Z, Almeida OP, Norman P, Hankey GJ, Yeap BB, et al. Quality use of medicines and health outcomes among a cohort of community dwelling older men: an observation study. Br J Clin Pharmacol 2011;71(4):592–9 http://dx.doi.org/10.1111/j.1365-2125.2010.03875.x
  57. Linjakumpu T, Hartikainen S, Klaukka T, Veijola J, Kivela SL, Isoaho R. Use of medications and polypharmacy are increasing among the elderly. J Clin Epidemiol 2002; 55(8):809–17. http://dx.doi.org/10.1016/s0895-4356(02)00411-0
  58. Spinewine A, Schmader KE, Barber N, Hughes C, Lapane KL, Swine C, et al. Appropriate prescribing in elderly people: how well can it be measured and optimised? Lancet 2007;370(9582):173–84. http://dx.doi.org/10.1016/s0140-6736(07)61091-5
  59. Gallagher G, Lang PO, Cherubini A, Topinková E, Cruz-Jentoft A, Errasquín BM, et al. Prevalence of potentially inappropriate prescribing in an acutely ill population of older patients admitted to six European hospitals. Eur J Clin Pharmacol 2011;67(11):1175–88. http://dx.doi.org/10.1007/s00228-011-1061-0
  60. Lapi F, Pozzi C, Mazzaglia G, Ungar A, Fumagalli S, Marchionni N, et al. Epidemiology of suboptimal prescribing in older, communitydwellers: a two wave, population-based survey in Dicomano, Italy. Drugs Aging 2009;26(12):1029–38. http://dx.doi.org/10.2165/11319390-000000000-00000
  61. Onder G, Landi F, Liperoti R, Fialova D, Gambassi G, Bernabei R. Impact of inappropriate drug use among hospitalized older adults. Eur J Clin Pharmacol 2005;61(5–6):1453–9. http://dx.doi.org/10.1007/s00228-005-0928-3

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