Polypharmacy – Too Much of a Bad Thing for Our Elderly!
Do you know someone who has more than four types of medication in the bathroom cabinet?
Rather than improving health outcomes, it’s a major cause for alarm – polypharmacy (the use of four or more medications by a patient) leads to an increased risk of frailty or death in our elderly as shown by research conducted by an Australian cohort.
Half of Australians over 65 years of age take at least five different types of medicine (prescription and non-prescription). Among over 75-year-olds, the numbers are even higher.
According Australian Bureau of Statistics, people aged 65 years comprise 14.7% of the population. The proportion of people aged 85 years and over has almost doubled to 2% of Australias total population.
Nearly half of this number are taking one or more unnecessary medications.
Frailty as defined by the study is characterised by low physiological reserves and limited ability to respond to stressors resulting from ever increasing decline across multiple body systems. It is a dynamic process whereby development of frailty can lead to a “spiral of decline” of increasing frailty and greater risk of worsening disability, hospital admission, falls, and death.
The study followed about about 1,700 community-dwelling men aged 70 years and older over a nine-year period.
The research investigated both their polypharmacy and the effect of taking certain types of sedative and anticholinergic medicine combinations.
The cohort used the Drug Burden Index (DBI) which is a pharmacological risk assessment tool that assesses cumulative exposure to sedative and anticholinergic medications according to the principles of dose-response and maximal effect.
Sedative medicines encompass a wide variety of drugs with different mechanisms of action that can induce depression of the central nervous system (CNS). They include barbiturates and benzodiazepines, sedative hypnotics and some antihistamines.
Anticholinergic medicines block the neurotransmitter acetylcholine in the central and the peripheral nervous system. They are prescribed for many gastrointestinal, genitourinary and respiratory disorders.
The study provided evidence that each additional medication within the DBI was associated with greater risk of transitioning from a robust state of health to death.
An interesting finding was that there was no statistical evidence of the effects of number of medications and DBI on transitions from the prefrail and frail states, which suggests that once a participant became prefrail or frail that other factors were responsible for this transition.
As Associate Professor Simon Bell states “What we found was that [for] people who took a higher number of medicines, for each additional medicine there was a 22 per cent increase [in the] risk of transitioning from a state of robust health to dying over the study period.
“And we also found those men who use sedative and anticholinergic medicines to a great degree or to a high extent were also more likely to become pre-frail or to develop frailty over the study period.”
Co-author Dr Danijela Gnjidic notes that there are several reasons for this finding:
- An older person will have many other diseases for which they’ll be prescribed/ using other medications.
- Their health or quality of life changes over (a shorter) time frame.
- Older people are exposed to many other medications and the way their body handles these medications will be different compared to younger individuals, who typically are more resilient and will have the capacity to handle these medications. This leads to a number of clinical consequences, including development of frailty and disability, which will then lead to increased risk of mortality.
What Can be Done to Minimise the Risk to our Older Citizens?
It is undeniable that minimising unnecessary medication use maintains quality of life and reduces hospitalisation (especially) in our older generations.
The risk to benefit ratio of the medicines older people take change as they get older. The message for older people and their carers is clear; keep a regular check on the number of medications in use, and if more than one doctor is involved, make sure they all know what the others are prescribing.
The Australian Government has a Med Check program, where people can take their medication into pharmacies for a quick check of what they are taking.
In cases where some patients need a more in depth look at their medication, a home review can be organised. This is a one hour home medicine review involving an informal discussion with an accredited pharmacist to help people better manage their medications.
If you are concerned about a loved one and the amount of orthodox medication they use; not only consult with their prescribing doctors but give one of our friendly Emed team a call.
We can arrange a free initial consultation with you or your loved one either at out clinic in the eastern suburbs in Melbourne or via a video phone consultation to discuss their needs and requirements.
Emed – At Your Place or Ours!
- Effects of Changes in Number of Medications and Drug Burden Index Exposure on Transitions Between Frailty States and Death: The Concord Health and Ageing in Men Project Cohort Study
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