Polypharmacy, or using a number of medicines, is frequent in older adults. Whereas 89% of individuals aged 65 and older take a minimum of one prescription treatment, 54% take 4 or extra.1 Information from Merck equally discovered that just about 80% of older adults recurrently take a minimum of two prescribed drugs whereas 36% recurrently use 5 or extra totally different medication — and this doesn’t embrace over-the-counter medicines.2
Adversarial results from polypharmacy are frequent and should drive sufferers to hunt out ever-more medication to deal with the unwanted side effects brought on by their unsafe drug routine. It’s a vicious cycle, one which’s perpetuated by a damaged well being care system that revolves round pharmaceutical-driven, fragmented care.
Not solely do many sufferers see a number of medical doctors, every of whom might prescribe their very own set of medicines, however sufferers might strain medical doctors to prescribe medication they’ve seen on direct-to-consumer ads. As an alternative of wanting on the huge image of the right way to get wholesome, tending to important elements like weight loss plan, stress and bodily exercise, “well being care” for seniors usually turns into “drug care,” with doubtlessly disastrous outcomes.
One Affected person — 43 Prescription Medication
A commentary by Dr. Mark E. Williams revealed on Medscape highlights simply how excessive polypharmacy can grow to be. In some instances, it’s not “simply” 4 or 5 medicines however dozens of them, and within the case of Williams’ affected person “Allison,” it was 43. The girl had been transferred to a persistent care facility for long-term care as a result of bipolar sickness.
Days earlier, she was handled at a hospital for psychological well being points, which Williams mentioned “was in all probability associated to inappropriate polypharmacy.”3
“Regardless of being admitted to the hospital for hostile drug reactions associated to polypharmacy, Allison was discharged to my facility on 43 prescription medicines and an virtually equal variety of over-the-counter (OTC) medication. It took greater than 10 minutes for the nurse to evaluation the admission medicines with me over the cellphone,” he wrote.4
Allison’s signs included fatigue, dizziness, muscle aches, headache, nausea, insomnia and extra, and she or he requested further medicines to deal with them. Not solely was the girl taking duplicate medicines meant to deal with the identical signs, however she was additionally taking medicines meant to deal with frequent hostile results.
“The ‘chemical soup’ in her physique is resulting in psychological and bodily issues,” Williams informed the affected person’s daughter, however she, too, purchased into the notion that extra medication equaled higher care. After overcoming the affected person’s resistance to going off the medication, over a three-month interval Williams was capable of scale back Allison’s medicines to about 15 — nonetheless a staggering quantity, however much less so than 43.
“Allison improved, each mentally and bodily,” Williams wrote,5 however challenges nonetheless ensued, together with the affected person demanding a reminiscence drug she had seen marketed on tv, and an incident by which her daughter gave her an over-the-counter sleep support, resulting in lethargy, confusion and slurred speech.
Finally, Allison was transferred to a different facility, the place the harmful polypharmacy undoubtedly continued. Whereas Williams’ commentary highlights an excessive case, it’s not distinctive — polypharmacy is prevalent amongst seniors.
Polypharmacy Worsens Well being
When medicines are prescribed in extra, together with to deal with the unwanted side effects of different medication, the affected person’s well being suffers. “The usage of quite a few medicines might end in medication-related issues akin to inappropriate indications, therapeutic duplication, hostile results, drug interactions, pointless medicines, poor adherence and a pressure on well being care assets,” in accordance with a featured article in The Journal for Nurse Practitioners.6
It additionally famous that polypharmacy is a preventable threat issue for hospital admission in older adults, as a result of hostile drug occasions. The dangers of polypharmacy, in the meantime, are nicely famous. In BMC Geriatrics, hostile outcomes together with mortality, falls, hostile drug reactions, elevated size of hospital keep and hospital readmission are listed, and the chance of hurt will increase with the variety of medicines.7 Based on the systematic evaluation:8
“Hurt may result as a result of a mess of things together with drug-drug interactions and drug-disease interactions. Older sufferers are at even better threat of hostile results as a result of decreased renal and hepatic perform, decrease lean physique mass, decreased listening to, imaginative and prescient, cognition and mobility.”
In 2007, Dr. Michael Stern, geriatric emergency medication specialist at New York Presbyterian Hospital, even informed a New York Occasions reporter that polypharmacy accounts for greater than one-fourth of all admissions to the hospital and that it will be thought of the fifth main reason for dying if it had been categorized that approach.9
Older Individuals Are Extra Susceptible to Drug Aspect Results
The truth that older individuals are extra more likely to be taking extra prescribed drugs is a double-edged sword, because the aged are already at elevated threat of drug unwanted side effects. The truth is, the aged are estimated to be twice as vulnerable to hostile drug occasions in comparison with youthful individuals.
“Unwanted effects are additionally more likely to be extra extreme, affecting high quality of life and leading to visits to the physician and in hospitalization,” in accordance with the Merck Guide, which additionally explains a number of the reason why older individuals are so weak to drug unwanted side effects:10
- Older individuals have much less water and extra fats tissue within the physique; this enables larger concentrations of medicine that dissolve in water and elevated accumulation of medicine that dissolve in fats
- The kidneys are much less efficient at excreting medication into urine
- The liver is much less capable of metabolize medication, in order that they’re not eliminated as readily from the physique
- “Older individuals are extra more likely to have persistent medical issues that could be worsened by medication or which will have an effect on how the medication work”
Some frequent examples of how medication might have an effect on seniors in a different way embrace blood strain medication, which can result in extra dramatic drops in older individuals, resulting in signs of dizziness and falls. Older adults may additionally grow to be confused and sleepy when utilizing antianxiety medication, extra so than usually seen in youthful individuals. Such results might solely be compounded when a number of medication are being taken on the similar time.
The truth is, as a result of adjustments that happen throughout organic growing older, it’s now acknowledged that medicines must be clinically examined particularly with older adults in thoughts. Nonetheless, older adults are sometimes excluded from scientific trials, which suggests the protection and efficacy of medicine on this inhabitants is usually unknown, with supportive proof missing.
“Inevitably, this lack of proof has usually led to inappropriate drug therapy and, consequently, to varied hostile scientific outcomes,” in accordance with a evaluation revealed in March 2021 in European Geriatric Medication.11
Why Are so Many Extra Seniors Taking Antidepressants?
Overprescribing is rampant among the many senior inhabitants, and antidepressants are one such instance. There’s been a serious rise within the variety of antidepressants being prescribed for older adults during the last 20 years, with no equally sharp enhance within the quantity depressed, in accordance with a examine revealed in The British Journal of Psychiatry.12
The findings recommend seniors could also be being overprescribed antidepressant medication, which might have critical implications for his or her well being, though the researchers weren’t prepared to state this, noting as a substitute, “we will not infer that older sufferers are prescribed antidepressants unnecessarily.”13
Within the first examine group, 4.2% of the adults had been taking antidepressants, however this jumped to 10.7% within the later examine. Throughout this time, the prevalence of despair decreased, however solely barely, from 7.9% to six.8%.14 Additionally noteworthy, amongst older adults residing in care properties, the prevalence of despair was unchanged however using antidepressants rose from 7.4% to 29.2%.15
There have been a number of ideas supplied for why antidepressant prescribing charges elevated so steeply with no comparable enhance in despair, together with overdiagnosis or prescribing the medication for situations apart from despair. Nonetheless, most of these prescribed antidepressants had not been recognized with despair.
Additional, antidepressants carry a threat of unwanted side effects that might simply spiral into extra drug prescriptions. As an illustration, antidepressant customers have an elevated threat of creating Kind 2 diabetes,16 and antidepressant use has been linked to thicker arteries, which might contribute to the chance of coronary heart illness and stroke.17
Almost Half of Over 75s Take Statins
Statin cholesterol-lowering medication are one other instance of a wildly overprescribed drug class that’s contributing to polypharmacy dangers. Within the U.S., near 50% of U.S. adults over 75 years take a statin,18 although their use may additionally hurt mind well being — greater than doubling threat of dementia in some instances.19
A connection additionally exists between statins and diabetes, to the extent that individuals who take statins are greater than twice as more likely to be recognized with diabetes than those that don’t, and people who take the medication for longer than two years have greater than triple the chance.20,21 With a diabetes prognosis, in fact, comes extra medication.
Usually, statins are pointless within the first place. Whereas they’re efficient at decreasing ldl cholesterol, whether or not that is the panacea for serving to keep away from coronary heart illness and prolong lifespan is a subject of heated debate. In 2018, a scientific evaluation introduced substantial proof that top LDL and complete ldl cholesterol will not be a sign of coronary heart illness threat, and that statin therapy is of uncertain profit as a type of main prevention for that reason.22
Medication Don’t Equate to Good Well being
Overprescribing capsules is organising seniors for a downward spiral of accelerating unwanted side effects and worsening well being. A holistic strategy is required, one which addresses the important thing tenets of excellent well being and creates actual wellness as a substitute of making an attempt to cowl up signs with extra capsules.
As only one instance, in a examine of older depressed adults, 80% skilled a major discount in depressive signs after taking over power coaching for 10 weeks, such that researchers concluded that the train was “an efficient antidepressant in depressed elders, whereas additionally enhancing power, morale and high quality of life.”23
It’s necessary to work with a well being care supplier who understands the dangers of polypharmacy and the truth that good well being doesn’t come from a capsule. Solely by constructing a well being plan that addresses weight loss plan, train, sleep, emotional wellness and poisonous exposures, together with solely focused and actually crucial medicines and/or dietary supplements, are you able to attain optimum well being.