Hospital Resources - Medications & Polypharmacy

Prescription medications, over-the-counter (OTC) products, natural and alternative medicines are widely used in Canada, especially by seniors.(4)  Polypharmacy is the term usually used to describe multiple medication use by a single patient. Although the term is often used to describe a patient taking multiple medications, the better definition is likely, “use of at least one inappropriate drug.”(2)  Potentially inappropriate medications (PIMs) continue to be prescribed and used as first-line treatment for the most vulnerable of older adults, despite evidence of poor outcomes from the use of PIMs in older adults.(3)

Why is this Important?

  • Multiple medication use (taking five or more different drugs in the past two days) was reported for 53% of seniors in health care institutions and 13% of those in private households. (4)
  • The medications reported most commonly were those that act on the nervous system, the alimentary tract and metabolism, and the cardiovascular system. (4)
  • 78% of seniors in institutions and 37% of those in households took medications for the nervous system. Of these medications, analgesics were the most common, followed by psycholeptics, which include antipsychotics, anxiolytics, hypnotics and sedatives. (4)
  • Concurrent use of 5 or more medications was reported by 53% of seniors in institutions and 13% of those in households. (4)
  • Medication-related problems are common, costly, and often preventable in older adults and lead to poor outcomes.
  • Estimates from past studies in long-term care settings found  42% of ADEs (Adverse Drug Events) in long-term care were preventable, with most problems occurring at the ordering and monitoring stages of care (2)
  • Institutionalized seniors who had Alzheimer’s disease or other dementia were less likely to be taking multiple medication users than were institutionalized seniors without this condition (4)

Key Considerations

  • When conducting a medication review ask for all prescribed medications, OTC and herbal preparations
  • Medication reconciliation of newly transferred residents is valuable and an important quality process
  • Consider whether the medication is covered by Ontario Drug Benefit (ODB)
  • As patients become more frail, the potential harm from medications must be weighed against the benefits (2)
  • Follow the 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.        Ramage-Morin, P.  (2009).   Medication use among senior Canadians • Health Matters.   Statistics Canada,
           Catalogue no. 82-003-XPE • Health Reports, Vol. 20, no. 1, March 2009.  Retrieved Feb. 2014 from: 
           http://www.statcan.gc.ca/pub/82-003-x/2009001/article/10801-eng.pdf

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