Polypharmacy

Original Editor - Shwe Shwe U Marma Top Contributors - Shwe Shwe U Marma, Lucinda hampton and Kim Jackson

Introduction

Polypharmacy refers to the use of multiple medications in a patient, commonly an older adult. While the most commonly used definition of polypharmacy is being on five or more medicines, definitions are variable.

Catagories

There is no universally agreed definition of polypharmacy, however it can be described in 3 groups-

1. Excessive polypharmacy (EPP): concurrent use of ten or more different drugs.
2. Polypharmacy (PP): the use of five to nine drugs.
3. No polypharmacy: taking four or less drugs (included those taking no medicines)

Prevalence

• Individuals greater than 65 years old are the biggest consumers of medications; however, evidence shows that greater than 50% of elderly patients are taking at least one medication that is not medically necessary. Nearly 40% of elderly adults take more than five prescription medications and almost 20% take more than 10.
• Polypharmacy declines in patients older than 85 years of age secondary to poor drug tolerance with age and increasing deprescribing practices as medical providers fear serious adverse drug reactions that may be more common in the very elderly.

Associated Factors

Individual/Patient Factors	Physician Factors	Systems-Level Factors
Increasing age Female gender White ethnicity/race Lower socioeconomic status Poor self-reported health Multiple chronic conditions Declining nutrition/ability to function Decreased cognitive capacity Self-medication Use of over-the-counter medications Borrowing from friends/family Use of multiple pharmacies	Lack of education/competence High patient workload Prescribing habits Adherence to multiple medical guidelines Use of potentially inappropriate medications Improper medication reconciliation Poor physician-patient communication Multiple prescribers	Different electronic medical record systems Poor physician-physician communication Lack of continuity between multiple medical providers Ineffective transitions of care

Risks of Polypharmacy

• Multiple medications together at the same time can result in storing or taking them in wrong way, which eventually may lead to prescribing errors by clinicians. For example, the same type of medication might be prescribed twice.
• A medication may affect action of other medication which may result undesired effects.
• A medication used to treat a disease might affect another disease negatively. For example, anti-inflammatory medications may increase blood pressure and worsen kidney function.

Complications

This may result in various medication-related problems such as-

• Adverse effects
• Drug interactions
• Inappropriate therapy, or nonadherence.

Managing Polypharmacy

• List of prescribed medication should be updated and accurate
• Each clinician should review ongoing prescription
• Physician should be informed of any supplements, herbal products or over-the-counter medication, a patient taking
• Understanding the purpose of each medication
• Being aware of side effects of each medications
• Simplification of medication regimen
• Discontinuation of any medication if needed
• Taking medications as prescribed
• Taking any prescribed medication should not be stopped suddenly

Conclusion

Along with all other health practitioners, physiotherapists should be aware of the tools and methods to manage polypharmacy-related issues to optimize patient outcomes.