Care of the elderly
Polypharmacy from a pharmacist’s perspective (Part 1)
Polypharmacy is the prescribing of too many unnecessary or inappropriate medicines. Polypharmacy is not exclusive to older people, however due to the effect aging and “wear and tear” has on organs, the risk of polypharmacy increases as with age. There is no specific definition of polypharmacy but in general terms, polypharmacy is defined as the use of multiple drugs that is more than is medically necessary. There is no “standard cut of point” with regard numbers of medication prescribed to indicate polypharmacy. Medication has greatly improved our life expectancy and quality of life; however, the increase in use of numerous medications has many possible negative health consequences including side effects, drug-interactions, non-adherance to medications, decreased functional and mental status and high costs, all off which put increased strain on a health service that tends to operate on the verge of breaking point. In Ireland, polypharmacy accounts for over half of the annual costs of prescribing to the entire population aged over 50 years. The pharmacist has an important role in advising and reviewing prescribing and determining potentially inappropriate prescribing (i.e.) use of a medicine in which harms outweigh the benefits. The role out of a structured Medicine Use Review (MUR) system for pharmacists in Ireland the next few years should be welcomed and will be an important step in reducing inappropriate prescribing.
An Irish perspective.
A 2012 Trinity College Dublin based study called “Polypharmacy in adults over 50 in Ireland: Opportunities for cost saving and improved healthcare” showed that among Irish people aged over 50, 69% report taking medications regularly. The average number of medications taken regularly in the over 50s is 2, in the over 65s is 3 and in the over 75s is 4. Polypharmacy is more likely in patients who are older, have attained a lower educational level, have greater number of conditions, and have medical card eligibility. Although one in three people aged over 65 report polypharmacy, they are responsible for more than half of hospital outpatient and inpatient visits in this age group.
Residential care settings
My experience as a pharmacist who deals with patients in residential care settings is that regular pharmacist mediation reviews (at least every six months) with nurses and GPs results in significant reduction in unnecessary medication and more targeted prescribing. The advent of more specific guidelines from the Health, Information and Quality Authority (HIQA) and the Pharmaceutical Society of Ireland (PSI) on the role of the pharmacist in the review of medications for patients in residential care settings has helped in this area as it gives specific and clear guidance on what the role of the pharmacist should be.
Increased risk of adverse drug reactions
A 11-year study published in 2011 indicated that patients taking 5 or more medications had an 88% increased risk of experiencing a side effect compared to those who were prescribed less medications. In nursing home residents, the number of side effects are twice as high in patients taking 9 or more medications compared to those taking less.
To be continued…next week
References available upon request
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