Polypharmacy in Adults 60 and Older
By the time they reach age 60, most Americans are taking at least one prescription medication for a chronic health issue such as high blood pressure, high cholesterol or diabetes. Regular use of multiple prescriptions ― polypharmacy ― may raise the risk of overmedication, especially in older people.
Ariel Green, M.D., Ph.D., M.P.H., specializes in treating patients who have cognitive problems, and she conducts research on reducing the use of potentially harmful medications in older adults. She reviews the facts on polypharmacy, overmedication and their risks.
What You Need to Know
- People over 60, who may take daily medications for multiple chronic conditions, are at risk for overmedication and other complications of polypharmacy.
- Complications can include sedation, increased risk for falls and side effects. Taking a particular drug may lessen the effectiveness of another, or worsen its side effects.
- A prescription review with a doctor at least once a year can reduce patients’ use of prescriptions they no longer need, and can help them avoid unnecessary side effects and interactions.
What is polypharmacy?
Polypharmacy is using multiple prescription drugs. According to a report from the U.S. Centers for Disease Control and Prevention, about a third of American adults in their 60s and 70s use five or more prescription drugs regularly.
Though the definition of polypharmacy may vary among doctors and groups, it is recognized that the more medicines a person takes, the higher the chance of overmedication, side effects, oversedation and other problems.
Adults, particularly those 60 and older, may take multiple medicines for coexisting chronic conditions, such as:
- High blood pressure
- High cholesterol
- Coronary heart disease
Green says that some patients who were prescribed a medication years earlier for a condition may be continuing to take it when it is no longer necessary. She notes that “prescription cascade” can occur when patients are prescribed medications to offset side effects caused by other drugs they are taking, compounding the risk of polypharmacy.
Nonprescribed drugs and products factor in, too. Some herbal preparations and nutritional supplements are aggressively marketed to older adults with exaggerated claims and little scientific evidence to back up those claims. They can interact with prescription medicines and cause side effects. For instance, supplements made with gingko biloba may exaggerate the action of prescription blood thinners, putting a patient at risk for bleeding.
Symptoms of polypharmacy can include:
- Reduced alertness
- Confusion or cognitive problems
- Falls and accidents
- Weakness and dizziness
- Loss of appetite
- GI problems such as diarrhea, constipation or incontinence
- Skin rashes
Green says when she has a new patient or one who is experiencing symptoms such as these, she looks at the list of medications a patient is taking. “In geriatrics, we teach that when assessing symptoms in patients, think medications first,” she says. “When I see seven or 10 different meds, I consider the possibility of overmedication.”
Risks of Polypharmacy in Older Adults
Polypharmacy affects older women and men differently than younger people. For instance, some drugs work differently in older people. A person over the age of 60 may have a different body composition than a person who is 35, and may process medications differently.
Also, when new drugs are tested on people before going on the market, test subjects may not include older adults, so these differences are not always readily identified by the manufacturers.
Taking multiple prescription drugs can raise the risk of:
- Drug-drug interactions, in which one medication affects another
- Drug-disease interactions, in which taking a medication for one health problem makes another health problem worse
One of the most important risks of polypharmacy in adults over age 60 is oversedation, which can cause drowsiness or confusion and raise the risk of household and car accidents, especially in older adults and those who are frail.
According to Green, drugs that contribute to oversedation include:
- Opioid painkillers, which can also suppress breathing
- Benzodiazepines (medications for anxiety and agitation)
- Antihistamines, including over-the-counter drugs such as diphenhydramine
Alcohol, especially if used excessively, can increase the risk of oversedation when a person is taking these medications.
Dizziness and Loss of Balance
Taking certain medications can lead to dizziness and serious ― even life-threatening ― falls and household accidents.
Dizziness can be a side effect of sedating drugs or medications that lower blood pressure. Balance problems can also happen with anticholinergic drugs, which include some medications for urinary incontinence, heart disease, Parkinson’s disease and other conditions.
Green says the best polypharmacy prevention measure is regular checkups with a health care practitioner, including medication review.
“High-quality care means reviewing all the patient’s medications at least once a year and after any fall, hospitalization or emergency department visit. We try to understand why a patient is taking each medication, and whether they’re still benefiting from each one,” she says.
Green says that managing polypharmacy involves understanding what matters most to the patient ― whether it’s managing a health condition or avoiding intolerable side effects. It’s a highly individualized process that calls for careful listening and candid conversation.
“Medications can have trade-offs that are different for each person,” Green says. “Maintaining mobility and independence, preserving cognition, and controlling pain are often at the top of older patients’ priorities.”
Working As a Team
Bringing along a health advocate or caregiver to take notes and be a second set of ears can help the patient keep track of any changes to his or her drug regimen. Together, the patient, doctor and advocate or caregiver can:
- Review all the drugs the patient is taking and whether each is still benefiting the patient’s health.
- Spot drugs that may be interacting with other medications or health conditions.
- Discuss right-prescribing: Look at alternative drug options, formulas or dosages to minimize side effects.
“In some cases, we may deprescribe a drug that the patient no longer needs, or one in which the side effects are outweighing the medication’s benefit,” Green explains.
She says deprescription involves doctors working with the patient and family to ensure the patient is safely tapered off any medications that would cause problems if stopped abruptly, and monitoring them for the return of any health problems.
Working with Your Pharmacist
The patient’s pharmacist can also assist with medication management. Patients can benefit from having all their prescriptions at one pharmacy, where a pharmacist can be alert to potential drug interactions and help patients:
- Follow dosing times and amounts.
- Learn how to safely store their medications.
- Dispose of old or expired medications properly.
- Learn about new generics that may cost less.
- Schedule recommended vaccines.