Community Care Resources - Medications & Polypharmacy

Polypharmacy, defined as the use of five or more prescription medications is common among seniors and can lead to reduced adherence with medication regimens and problems with drug interactions.(4) Medication-related problems are common, costly, are preventable in older adults and can lead to poor outcomes. 

Why is this Important?

  • 27% of seniors report taking five or more medications on a regular basis (4)
  • 12% of seniors taking five or more medications experienced a side effect that required medical attention compared with 5% of seniors taking only one or two medications (4)
  • The number of prescription medications was associated with the rate of emergency department use (4)
  • Less than 50% of all seniors reported receiving a prescription medication review from their physician identifying potential side effects.(4)
  • 27% of adverse drug events (ADEs) in primary care were preventable, with most problems occurring at the ordering and monitoring stages of care (1)

Key Considerations

  • When conducting a medication review ask for all prescribed medications, OTC and herbal preparations
  • Monitor medication adherence, ask about common side effects and adverse occurrences especially when new medications have been ordered
  • As patients become more frail, the possible harm from preventative medications must be weighed against the benefits (1)
  • Follow BEERS criteria when prescribing and evaluating:
      • medications to avoid in older adults regardless of disease or conditions
      • medications considered inappropriate when used in older adults with certain conditions or syndromes
      • medications to consider for use in certain individuals recognizing the potential for misuse and harm is substantial (5)

References

1.     Campanelli, C. (2012).  American Geriatrics Society Updated Beers Criteria for Potentially Inappropriate
        Medication Use in Older Adult. 
Published online Feb 29, 2012.  Retrieved Feb.27, 2014 from: 
        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3571677/

2.     Frank, C.  (2010) Multiple medications in geriatric care.  OSMT Volume 17/Issue 2, Summer 2010. 
        Retrieved Feb. 2014 from:
        http://www.osmt.org/uploads/Multiple%20medications%20in%20geriatric%20care.pdf

3.     Institute for Safe Medication Practices Canada.  (2014). Safe Medication Use in Older Persons Information
        Page
.  Retrieved Feb. 2014 from: 
        https://www.ismp-canada.org/beers_list/

4.     Reason, B.  et al.  (2011) The impact of polypharmacy on the health of Canadian seniors. Oxford Journals. 
        Medicine, Family Practice.  Volume 29, Issue 4Pp. 427-432.  Retrieved Feb. 27, 2014 from: 
        http://fampra.oxfordjournals.org/content/29/4/427.long  

5.     The American Geriatrics Society. (2012).American Geriatrics Society Updated Beers Criteria for
        Potentially Inappropriate Medication Use in Older Adults, Beers Criteria Update Expert panel, 
       
Journal of American Geriatrics Society (2012), 1-16, Retrieved May 2014 from:
        
http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines